Provider Demographics
NPI:1982406625
Name:MIXER-KEPHART, HANNAH VICTORIA (MD)
Entity type:Individual
Prefix:DR
First Name:HANNAH
Middle Name:VICTORIA
Last Name:MIXER-KEPHART
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:
Other - Last Name:MIXER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1274 HAMPSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-9218
Mailing Address - Country:US
Mailing Address - Phone:980-613-0160
Mailing Address - Fax:
Practice Address - Street 1:300 SINGLETON RIDGE RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-9142
Practice Address - Country:US
Practice Address - Phone:843-234-7405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program