NPIMap

Individual provider Active NPI

Keely Nicole Mixon, PA

  • Physician Assistant
  • Pensacola, FL
National Provider Identifier
1710181714
Registry record updated Dec 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.200255 Issued in LA
Practice address
5151 N 9TH Ave
Pensacola, FL 32504-8721
Phone
(850) 416-7619
Fax
(850) 416-7753
NPI assigned
Jun 13, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9110923 FL
Physician Assistant 363A00000X PA.1523 AL
Physician Assistant 363A00000X PA.200255 LA Primary

Addresses

Primary practice location

5151 N 9TH Ave
Pensacola, FL 32504-8721

Mailing address

PO Box 2699
Pensacola, FL 32513-2699
Phone (850) 416-7619

Other identifiers 1

IdentifierTypeStateIssuer
1380709MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA, FL, AL3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20100928000059 LA Practitioner - Physician Assistant 0345335055 Reassigns benefits to 13 organizations
I20180130002940 FL Practitioner - Physician Assistant 0345335055 Reassigns benefits to 1 organization
I20200406001330 AL Practitioner - Physician Assistant 0345335055 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
96.73 of 100Reported as group
Quality
84.95
Improvement activities
40
Cost
85.77

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Urgent Care Ascension LLC CurrentSince Aug 25, 2013 Accepting new patients
Lake Urgent Care Ascension LLC CurrentSince Aug 25, 2013 Accepting new patients
Lourdes After Hours LLC CurrentSince Jan 28, 2013 Accepting new patients
Our Lady of the Lake Physician Group LLC CurrentSince Apr 1, 2015 Accepting new patients
Convenient Care LLC CurrentSince Oct 29, 2013 Accepting new patients
Convenient Care LLC CurrentSince Oct 29, 2013 Accepting new patients
Lake Charles Primary Care and Wellness Past Accepting new patients

Locations

12525 Perkins Rd
#B
Baton Rouge, LA 70810
Phone (225) 819-8857

10319 Jefferson Hwy
Baton Rouge, LA 70809
Phone (224) 214-9352

3824 NE Evangeline Thruway
Carencro, LA 70520
Phone (337) 565-2675

31985 LA Highway 16
Denham Springs, LA 70726
Phone (225) 485-3521

14350 Highway 73
Prairieville, LA 70769
Phone (225) 313-3930

Organizations & group practices 20

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1181692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576454400000",
    "number": "1710181714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2699",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325132699",
            "telephone_number": "850-416-7619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5151 N 9TH AVE",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325048721",
            "telephone_number": "850-416-7619",
            "fax_number": "850-416-7753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIXON",
        "first_name": "KEELY",
        "middle_name": "NICOLE",
        "name_prefix": "Miss",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-13",
        "last_updated": "2019-12-16",
        "certification_date": "2019-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9110923",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AL",
            "license": "PA.1523",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "LA",
            "license": "PA.200255",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1380709",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pensacola, FL

Sources for this page

Verify at the official NPI Registry.