Healthcare Provider Details

I. General information

NPI: 1093369407
Provider Name (Legal Business Name): KAYLEE NICOLE SEXTON RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 08/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 N STATE ST # SR
IOLA KS
66749-1677
US

IV. Provider business mailing address

10175 TIMBERLINE CIR
JOPLIN MO
64804-8370
US

V. Phone/Fax

Practice location:
  • Phone: 620-380-6600
  • Fax:
Mailing address:
  • Phone: 620-778-5250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2017036803
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number12312
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: