Healthcare Provider Details

I. General information

NPI: 1629762059
Provider Name (Legal Business Name): KELLY BRYANT SEXTON WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 07/31/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 BYRD WAY
WARNER ROBINS GA
31088-8937
US

IV. Provider business mailing address

130 BYRD WAY
WARNER ROBINS GA
31088-8937
US

V. Phone/Fax

Practice location:
  • Phone: 478-922-9136
  • Fax:
Mailing address:
  • Phone: 478-922-9136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN172580
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: