1. Home
  2. Directory
  3. Washington
  4. Kirkland
  5. Specialist
  6. NPI Profile

LONGEVITY MEDICAL CLINIC
NPI 1023231172
Specialist in Kirkland, WA

Active since April 10, 2007CLIA Certified · 2 labs
9757 NE JUANITA DR, SUITE 200, KIRKLAND, WA 98034(425) 576-9272(425) 576-0894 Get Directions Write a Review

NPPES record last updated: June 21, 2011. Verified against the NPPES registry weekly; last sync: August 30, 2026.

About Longevity Medical Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LONGEVITY MEDICAL CLINIC (NPI 1023231172) is a healthcare organization registered as a specialist in Kirkland, Washington and active in the NPI registry since April 2007. The organization holds 2 active CLIA laboratory certificates and lists Jerry N Mixon, Medical Director, as its authorized official.

NPPES Registry Identity

NPI1023231172
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameLONGEVITY MEDICAL CLINIC
Location Address9757 NE JUANITA DR, SUITE 200Kirkland, WA 98034-4299
Mailing Address9757 Ne Juanita Dr, Suite 200Kirkland, WA 98034-4299 · (425) 576-9272 · Fax (425) 576-0894
Phone(425) 576-9272
Fax(425) 576-0894
Organization SubpartNo
Authorized OfficialJerry N MixonMedical Director · (425) 576-9272
Enumeration DateApril 10, 2007
Last NPPES UpdateJune 21, 2011
✔ NPI 1023231172 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in WA · MD23643
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
9757 NE JUANITA DR, Kirkland, WA 98034
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 50D2337389

Longevity Medical Clinic - Tacoma Clinic · Tacoma, WA
Active · expires Apr 4, 2028
CLIA Number50D2337389
Laboratory TypeCommunity Clinic
Certificate Effective DateJanuary 22, 2026
Certificate Expiration DateApril 4, 2028
Laboratory DirectorMichael Murphy
Laboratory Phone(425) 576-9272
Laboratory LocationLongevity Medical Clinic - Tacoma Clinic3518 6th Ave, Suite 200, Tacoma, WA 98406
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 50D2337328

Longevity Medical Clinic - Kirkland Clinic · Kirkland, WA
Active · expires Apr 4, 2028
CLIA Number50D2337328
Laboratory TypeCommunity Clinic
Certificate Effective DateJanuary 21, 2026
Certificate Expiration DateApril 4, 2028
Laboratory DirectorMichael Murphy
Laboratory Phone(425) 576-0972
Laboratory LocationLongevity Medical Clinic - Kirkland Clinic11335 NE 122nd Way, Suite # 250, Kirkland, WA 98034
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 9

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. JANET ROSE CANNIFF LMHC
Counselor (Mental Health)
9757 NE JUANITA DR, SUITE 102
KIRKLAND, WA 98034
King County (800) 433-8373
MS. DEBORAH D GRAY MSW, MPA
Social Worker (Clinical)
9757 NE JUANITA DR, SUITE 129
KIRKLAND, WA 98034
King County (206) 819-2017
DR. JERRY NELSON MIXON MD
Family Medicine (Adult Medicine)
9757 NE JUANITA DR, 202
KIRKLAND, WA 98034
King County (425) 605-8715
ANGELA FARRAR SMALL
Social Worker (Clinical)
9757 NE JUANITA DR, STE 214
KIRKLAND, WA 98034
King County (425) 286-8727
DR. PADMINI BHASKAR M.D.
Specialist
9757 NE JUANITA DR, SUITE 200
KIRKLAND, WA 98034
King County (425) 576-9272
MEAGAN MCKEE
Counselor (Mental Health)
9757 NE JUANITA DR
KIRKLAND, WA 98034
King County (206) 669-2310
LONGEVITY LABORATORY, LLC
Clinical Medical Laboratory
9757 NE JUANITA DR, 202
KIRKLAND, WA 98034
King County (425) 605-8715
JESSICA PSENSKI LMHCA
Counselor (Mental Health)
9757 NE JUANITA DR
KIRKLAND, WA 98034
King County (425) 638-2127

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Longevity Medical Clinic's NPI number?

The NPI number for Longevity Medical Clinic is 1023231172. It was assigned to this organization in the NPPES registry on April 10, 2007.

Where is Longevity Medical Clinic located?

Longevity Medical Clinic is located at 9757 NE Juanita Dr Suite 200, Kirkland, WA 98034. The listed phone number is (425) 576-9272.

What is Longevity Medical Clinic's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Does Longevity Medical Clinic hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Longevity Medical Clinic was last updated on June 21, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.