Healthcare Provider Details

I. General information

NPI: 1841641727
Provider Name (Legal Business Name): JASMYNE MARIE SEXTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 06/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5350 CAMELOT DR APT 13
FAIRFIELD OH
45014-4091
US

IV. Provider business mailing address

5350 CAMELOT DR APT 13
FAIRFIELD OH
45014-4091
US

V. Phone/Fax

Practice location:
  • Phone: 513-638-2175
  • Fax:
Mailing address:
  • Phone: 513-638-2175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: