Healthcare Provider Details

I. General information

NPI: 1568905107
Provider Name (Legal Business Name): DTAWAHN SEXTON DNP, FNP-BC, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2016
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8695 COMMERCE DR STE 5
EASTON MD
21601-7485
US

IV. Provider business mailing address

450 S KITSAP BLVD
PORT ORCHARD WA
98366-3773
US

V. Phone/Fax

Practice location:
  • Phone: 410-822-5575
  • Fax: 410-770-3258
Mailing address:
  • Phone: 360-874-5900
  • Fax: 253-952-6824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60863630
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN216522
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2016024386
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR251567
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: