Healthcare Provider Details

I. General information

NPI: 1609020528
Provider Name (Legal Business Name): JAMIE M SEXTON RDE MED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE M PRATT

II. Dates (important events)

Enumeration Date: 11/05/2008
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 WATSON RD
BIDWELL OH
45614-9580
US

IV. Provider business mailing address

828 WATSON RD
BIDWELL OH
45614-9580
US

V. Phone/Fax

Practice location:
  • Phone: 740-441-1350
  • Fax:
Mailing address:
  • Phone: 740-441-1350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number728
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: