Healthcare Provider Details

I. General information

NPI: 1568393775
Provider Name (Legal Business Name): KALEY ELIZABETH MIXON MS, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5109 W ENTERPRISE ST # B
NORTH CHARLESTON SC
29405-4066
US

IV. Provider business mailing address

127 LEBANON FARM LN
RIDGEVILLE SC
29472-7367
US

V. Phone/Fax

Practice location:
  • Phone: 843-746-1300
  • Fax:
Mailing address:
  • Phone: 843-599-9228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberATR.1163ATH
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: