MEDICARE: MR. JAMES RANDOLPH SEXTON NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN045574	AZ

General Provider Information

NPI Number	:	1710983804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES RANDOLPH SEXTON NP

Provider Business Mailing Address
First Line	:	21173 E CALLE DE FLORES
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85242-6971
Country	:	US
Telephone Number	:	480-888-9092
Fax Number	:

Provider Business Practice Location Address
First Line	:	6950 E WILLIAMS FIELD RD
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85212-6033
Country	:	US
Telephone Number	:	602-222-6568
Fax Number	:	602-222-6496

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	07/08/2007

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