Mixed Roots LLC

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

MIXED ROOTS LLC

Practice address

6300 Creedmoor Rd Ste 118
Raleigh, NC 27612-6730

Phone

(919) 720-4080

NPI assigned

Jan 18, 2024

Organization subpart

No

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

Authorized official

Name

Patricia McCray, STYLIST

Title

Salon Owner

Phone

(856) 236-6555

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1705536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705536000000",
    "number": "1962263871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10624 SUNNY POINT DR",
            "city": "ZEBULON",
            "state": "NC",
            "postal_code": "275976880",
            "telephone_number": "856-236-6555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6300 CREEDMOOR RD STE 118",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276126730",
            "telephone_number": "919-720-4080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIXED ROOTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-18",
        "last_updated": "2024-01-18",
        "certification_date": "2024-01-17",
        "status": "A",
        "authorized_official_last_name": "MCCRAY",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "SALON OWNER",
        "authorized_official_telephone_number": "856-236-6555",
        "authorized_official_credential": "STYLIST"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Prosthetic/Orthotic Supplier in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Prosthetic/Orthotic Supplier in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2024; 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.