MEDICARE: DEBBIE M MIXON-COOPER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1225633126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBBIE M MIXON-COOPER

Provider Business Mailing Address
First Line	:	12401 BRICKYARD BLVD APT 1056
Second Line	:
City	:	BELTSVILLE
State	:	MD
Zip	:	20705-1348
Country	:	US
Telephone Number	:	240-273-2140
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 FLORIDA AVE NE APT 305
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20002-5012
Country	:	US
Telephone Number	:	240-273-2140
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2020
Last Update Date	:	12/01/2020

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Directions to “ DEBBIE M MIXON-COOPER ” Practice Location

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