Healthcare Provider Details

I. General information

NPI: 1194534305
Provider Name (Legal Business Name): KAYLA SEXTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23800 NORTHWESTERN HWY STE 190L
SOUTHFIELD MI
48075-7740
US

IV. Provider business mailing address

632 W FOREST AVE
DETROIT MI
48201-1154
US

V. Phone/Fax

Practice location:
  • Phone: 877-927-8461
  • Fax:
Mailing address:
  • Phone: 734-552-4992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberPM6H5E5S9
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: