Healthcare Provider Details

I. General information

NPI: 1437152279
Provider Name (Legal Business Name): MICHAEL A SEXTON AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 06/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 KENTUCKY AVE DOB 3, SUITE 601
PADUCAH KY
42003-3800
US

IV. Provider business mailing address

2605 KENTUCKY AVE DOB 3, SUITE 601
PADUCAH KY
42003-3800
US

V. Phone/Fax

Practice location:
  • Phone: 270-408-4368
  • Fax: 270-408-3272
Mailing address:
  • Phone: 270-408-4368
  • Fax: 270-408-3272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number0449
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number0632
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberKY-0449
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberKY-0917
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: