Longevity Laboratory, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

LONGEVITY LABORATORY, LLC

Practice address

9757 NE Juanita Dr
202
Kirkland, WA 98034-4299

Phone

(425) 605-8715

Fax

(425) 654-0211

NPI assigned

Aug 13, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jerry Nelson Mixon, MDNPI 1366799090

Title

Medical Director

Phone

(425) 605-8715

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jerry Nelson Mixon, MD

  • Adult Medicine Physician
  • Kirkland, WA
  • NPI 1366799090
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1344816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344816000000",
    "number": "1609123330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9757 NE JUANITA DR",
            "address_2": "202",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980344299",
            "telephone_number": "425-605-8715",
            "fax_number": "425-654-0211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9757 NE JUANITA DR",
            "address_2": "202",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980344299",
            "telephone_number": "425-605-8715",
            "fax_number": "425-654-0211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGEVITY LABORATORY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-13",
        "last_updated": "2012-08-13",
        "status": "A",
        "authorized_official_last_name": "MIXON",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "NELSON",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "425-605-8715",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacquelyn Marie Lombari, MS, CNS
• Katie London
• Kimberlee Ann Lonergan, ARNP
• Alissa Long, RN
• Theresa Cronin Long, RN
• Longevity Medical Clinic
• Mark L Looper, PT
• Jeysi Adelina Lopez Ramirez, MA 60469504
• Flavio Lopez
• Yadira Lopez

• Clinical Medical Laboratory in Kirkland, WA
• Providers in Kirkland, WA by specialty
• Clinical Medical Laboratory in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.