Healthcare Provider Details

I. General information

NPI: 1255822383
Provider Name (Legal Business Name): MIXON INTEGRATED HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2018
Last Update Date: 05/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 S SHILOH RD STE 107
GARLAND TX
75042-8234
US

IV. Provider business mailing address

1919 S SHILOH RD STE 107
GARLAND TX
75042-8234
US

V. Phone/Fax

Practice location:
  • Phone: 972-840-2520
  • Fax: 972-840-2435
Mailing address:
  • Phone: 972-840-2520
  • Fax: 972-840-2435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PAMELA SPEIGHTS
Title or Position: CREDENTIALIST
Credential:
Phone: 817-987-1466