Healthcare Provider Details

I. General information

NPI: 1174819825
Provider Name (Legal Business Name): JEREMY ELLIOTT SEXTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 BACK RD
OCRACOKE NC
27960-1007
US

IV. Provider business mailing address

614 HOWARD ST
BOONE NC
28608-0020
US

V. Phone/Fax

Practice location:
  • Phone: 252-928-1511
  • Fax:
Mailing address:
  • Phone: 252-262-3100
  • Fax: 828-262-6958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2014-01448
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: