| NPI | 1790148823 |
|---|---|
| Former Name | MORGAN MIRANDA MIXON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: SC 2536) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC TL2536) |
| Enumeration Date | 2016-04-05 |
| Last Update Date | 2021-01-29 |