Provider Demographics
NPI:1174795017
Name:MIXON, AMANDA M (PA-C)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:M
Last Name:MIXON
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1715 IRON HORSE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-9617
Mailing Address - Country:US
Mailing Address - Phone:720-494-4700
Mailing Address - Fax:720-494-4706
Practice Address - Street 1:1715 IRON HORSE DR STE 100
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-9617
Practice Address - Country:US
Practice Address - Phone:720-494-4700
Practice Address - Fax:720-494-4706
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2020-02-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
COPA.0002872363AM0700X, 363AM0700X
IL085004719363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical