Healthcare Provider Details

I. General information

NPI: 1245043942
Provider Name (Legal Business Name): JAMEY MIXSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6267 WILSON MILLS RD # A-2
HIGHLAND HEIGHTS OH
44143-2127
US

IV. Provider business mailing address

6267 WILSON MILLS RD # A-2
HIGHLAND HEIGHTS OH
44143-2127
US

V. Phone/Fax

Practice location:
  • Phone: 440-566-0157
  • Fax:
Mailing address:
  • Phone: 440-566-0157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: