MEDICARE: KRISTIE MICHELLE MIXON

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	101YP2500X	Professional Counselor	P-1553	MS

General Provider Information

NPI Number	:	1932999398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIE MICHELLE MIXON

Provider Business Mailing Address
First Line	:	207 N STEELE AVE
Second Line	:
City	:	PICAYUNE
State	:	MS
Zip	:	39466-4077
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	315 N MAIN ST
Second Line	:
City	:	PICAYUNE
State	:	MS
Zip	:	39466-3313
Country	:	US
Telephone Number	:	985-774-1668
Fax Number	:

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

Provider Enumeration Date	:	05/08/2025
Last Update Date	:	04/20/2026

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Directions to “ KRISTIE MICHELLE MIXON ” Practice Location

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