Healthcare Provider Details

I. General information

NPI: 1447030903
Provider Name (Legal Business Name): STACY R SEXTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 BAXTER AVE
LOUISVILLE KY
40204-1157
US

IV. Provider business mailing address

633 BAXTER AVE
LOUISVILLE KY
40204-1157
US

V. Phone/Fax

Practice location:
  • Phone: 502-309-2408
  • Fax:
Mailing address:
  • Phone: 502-309-2408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: