Active NPI
Kimberlee R. Mixon, P.A.
- Physician Assistant
- Enid, OK
National Provider Identifier
1598706491
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1288
- Practice address
- 600 S Monroe St
Enid, OK 73701-7211 - Phone
- (580) 233-2300
- Fax
- (580) 548-1489
- NPI assigned
- Jun 10, 2006
- Last updated
- Feb 12, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1288 | OK | Primary |
Addresses
Primary practice location
600 S Monroe St
Enid, OK 73701-7211
Mailing address
1705 E 19TH St
Ste 302
Tulsa, OK 74104-5410
Phone (580) 748-7585
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200037170A | Medicaid | OK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found.
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1288 | OK | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Panhandle Womens Center P L L C | Past | Accepting new patients | |
| St. John Physicians, Inc. | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Specialist
- Guymon, OK
- NPI 1336172857
-
- Internal Medicine Physician
- Tulsa, OK
- NPI 1336194406
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149897600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1518393600000",
"number": "1598706491",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1705 E 19TH ST",
"address_2": "STE 302",
"city": "TULSA",
"state": "OK",
"postal_code": "741045410",
"telephone_number": "580-748-7585"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 S MONROE ST",
"city": "ENID",
"state": "OK",
"postal_code": "737017211",
"telephone_number": "580-233-2300",
"fax_number": "580-548-1489"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIXON",
"first_name": "KIMBERLEE",
"middle_name": "R.",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-10",
"last_updated": "2018-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "OK",
"license": "1288",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200037170A",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Enid, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.