Healthcare Provider Details

I. General information

NPI: 1891659207
Provider Name (Legal Business Name): LYDIA SEXTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W NIFONG BLVD STE 101
COLUMBIA MO
65203-4469
US

IV. Provider business mailing address

809 E GREEN MEADOWS RD APT 208
COLUMBIA MO
65201-3754
US

V. Phone/Fax

Practice location:
  • Phone: 573-815-6640
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: