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General NPI Number Information
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NPI Number | 1285375188
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Entity Type | Individual
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Provider Name | D'ANDRA MIXON-WALKER PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/05/2022
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Last Update Date | 04/05/2022
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Provider Practice Location Address
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Address Line | 7450 W 63RD ST
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City | SUMMIT
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State | IL
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Zip | 60501-1816
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Country | US
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Telephone | 708-458-0757
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Fax |
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Provider Business Mailing Address
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Address Line | 1724 E 36TH AVE
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City | DENVER
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State | CO
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Zip | 80205-4033
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Country | US
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Telephone | 720-327-0122
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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