Healthcare Provider Details

I. General information

NPI: 1134595135
Provider Name (Legal Business Name): MISS KRISTEN N MIXON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2015
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E BETHPAGE RD
PLAINVIEW NY
11803-4228
US

IV. Provider business mailing address

60 FAIRMOUNT BLVD
GARDEN CITY NY
11530-5130
US

V. Phone/Fax

Practice location:
  • Phone: 516-731-5588
  • Fax:
Mailing address:
  • Phone: 516-241-0260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number025926
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: