Provider Demographics
NPI:1285375188
Name:MIXON-WALKER, D'ANDRA (PA-C)
Entity type:Individual
Prefix:
First Name:D'ANDRA
Middle Name:
Last Name:MIXON-WALKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 E 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-4033
Mailing Address - Country:US
Mailing Address - Phone:720-327-0122
Mailing Address - Fax:
Practice Address - Street 1:7450 W 63RD ST
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:IL
Practice Address - Zip Code:60501-1816
Practice Address - Country:US
Practice Address - Phone:708-458-0757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant