Healthcare Provider Details

I. General information

NPI: 1710983804
Provider Name (Legal Business Name): JAMES RANDOLPH SEXTON NP
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6950 E WILLIAMS FIELD RD
MESA AZ
85212-6033
US

IV. Provider business mailing address

21173 E CALLE DE FLORES
QUEEN CREEK AZ
85242-6971
US

V. Phone/Fax

Practice location:
  • Phone: 602-222-6568
  • Fax: 602-222-6496
Mailing address:
  • Phone: 480-888-9092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN045574
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: