Provider Demographics
NPI:1548213226
Name:MIXON, SUSAN PEE (NPC)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:PEE
Last Name:MIXON
Suffix:
Gender:F
Credentials:NPC
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Other - Credentials:
Mailing Address - Street 1:PO BOX 24146
Mailing Address - Street 2:UNIVERSITY PHYSICIANS PLLC
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39225-4146
Mailing Address - Country:US
Mailing Address - Phone:601-815-5047
Mailing Address - Fax:601-815-9596
Practice Address - Street 1:2500 NORTH STATE STREET
Practice Address - Street 2:DEPARTMENT OF MEDICINE DIVISION OF GEN INTERNAL MED
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216
Practice Address - Country:US
Practice Address - Phone:601-815-5670
Practice Address - Fax:601-984-6870
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2008-08-20
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Provider Licenses
StateLicense IDTaxonomies
MSR784973363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06370000Medicaid
Q13370Medicare UPIN
MS500001469Medicare ID - Type Unspecified
MS500002099Medicare ID - Type Unspecified
MS06370000Medicaid