Healthcare Provider Details

I. General information

NPI: 1851069421
Provider Name (Legal Business Name): STEPHANIE M SEXTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2522 E 70TH ST
SHREVEPORT LA
71105-4002
US

IV. Provider business mailing address

408 N JODIE ST
SHREVEPORT LA
71107-1816
US

V. Phone/Fax

Practice location:
  • Phone: 318-795-3388
  • Fax:
Mailing address:
  • Phone: 318-455-7683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: