Healthcare Provider Details

I. General information

NPI: 1689164865
Provider Name (Legal Business Name): ARIEL LEANDRA SEXTON DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ARIEL LEANDRA ABNER DPM

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 07/28/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 W 5TH ST STE 3
LONDON KY
40741-1610
US

IV. Provider business mailing address

1105 W 5TH ST STE 3
LONDON KY
40741-1610
US

V. Phone/Fax

Practice location:
  • Phone: 606-862-9900
  • Fax:
Mailing address:
  • Phone: 606-862-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number267622
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: