Healthcare Provider Details

I. General information

NPI: 1003377581
Provider Name (Legal Business Name): MS. CAROLYN A SEXTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 LAKE COLONY DR
VESTAVIA AL
35242-7408
US

IV. Provider business mailing address

505 LAKE COLONY DR
VESTAVIA AL
35242-7408
US

V. Phone/Fax

Practice location:
  • Phone: 205-914-4234
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-150519
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: