Healthcare Provider Details

I. General information

NPI: 1336545649
Provider Name (Legal Business Name): EMILY SEXTON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2014
Last Update Date: 03/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N KENTUCKY AVE
WEST PLAINS MO
65775-2029
US

IV. Provider business mailing address

222 SIMPSON ST
WEST PLAINS MO
65775-3744
US

V. Phone/Fax

Practice location:
  • Phone: 417-372-0056
  • Fax:
Mailing address:
  • Phone: 417-372-0056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2014036339
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: