Healthcare Provider Details

I. General information

NPI: 1619600079
Provider Name (Legal Business Name): TAMMY JEAN SEXTON LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2022
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 GALLIA ST
PORTSMOUTH OH
45662-4232
US

IV. Provider business mailing address

3342 BIG RUN RD
LUCASVILLE OH
45648-8910
US

V. Phone/Fax

Practice location:
  • Phone: 740-353-3236
  • Fax: 740-353-4803
Mailing address:
  • Phone: 740-821-5576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN.145765.MEDS-IV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: