Healthcare Provider Details

I. General information

NPI: 1184673626
Provider Name (Legal Business Name): SHAWNA M. SEXTON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 02/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 HOSPITAL ST
MONTICELLO KY
42633-2416
US

IV. Provider business mailing address

166 HOSPITAL ST
MONTICELLO KY
42633-2416
US

V. Phone/Fax

Practice location:
  • Phone: 606-340-3251
  • Fax: 606-348-0618
Mailing address:
  • Phone: 606-340-3251
  • Fax: 606-348-0618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number03246
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: