Healthcare Provider Details

I. General information

NPI: 1336457639
Provider Name (Legal Business Name): KIMBERLY BRADY SEXTON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2010
Last Update Date: 07/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 LANGDON ST
SOMERSET KY
42503-2750
US

IV. Provider business mailing address

305 LANGDON ST
SOMERSET KY
42503-2750
US

V. Phone/Fax

Practice location:
  • Phone: 606-678-3288
  • Fax: 606-679-3108
Mailing address:
  • Phone: 606-678-3288
  • Fax: 606-679-3108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number276173
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number85591
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: