Healthcare Provider Details

I. General information

NPI: 1255355236
Provider Name (Legal Business Name): CALLIE MINTER SEXTON FAMILY NURSE PRACTIT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 W CALHOUN
MAGNOLIA AR
71753-3506
US

IV. Provider business mailing address

5552 MEADOWSWEET CIR
BOSSIER CITY LA
71112-8820
US

V. Phone/Fax

Practice location:
  • Phone: 870-235-3798
  • Fax:
Mailing address:
  • Phone: 318-747-3550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA01818
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: