Healthcare Provider Details

I. General information

NPI: 1740926518
Provider Name (Legal Business Name): KATIE LEE MIXON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2022
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF TEXAS MEDICAL BRANCH 301 UNIVERSITY BLVD
GALVESTON TX
77555-0001
US

IV. Provider business mailing address

UNIVERSITY OF TEXAS MEDICAL BRANCH 301 UNIVERSITY BLVD
GALVESTON TX
77555-0001
US

V. Phone/Fax

Practice location:
  • Phone: 409-747-1883
  • Fax: 409-747-8579
Mailing address:
  • Phone: 409-747-1883
  • Fax: 409-747-8579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberBP10079528
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberV7584
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: