Healthcare Provider Details

I. General information

NPI: 1932739554
Provider Name (Legal Business Name): LELAND JAY SEXTON JR. APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 GREENBRIAR DR
GRAYSON KY
41143-1746
US

IV. Provider business mailing address

224 GREENBRIAR DR
GRAYSON KY
41143-1746
US

V. Phone/Fax

Practice location:
  • Phone: 606-316-4454
  • Fax:
Mailing address:
  • Phone: 606-316-4454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3013247
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: