MEDICARE: NATHAN THOMAS OLDMIXON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0200X	Critical Care Medicine Registered Nurse	R857616	MS

General Provider Information

NPI Number	:	1376137620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHAN THOMAS OLDMIXON

Provider Business Mailing Address
First Line	:	3518 HASTINGS LN
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-3315
Country	:	US
Telephone Number	:	228-697-4292
Fax Number	:

Provider Business Practice Location Address
First Line	:	3518 HASTINGS LN
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-3315
Country	:	US
Telephone Number	:	228-697-4292
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2021
Last Update Date	:	02/26/2021

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