Healthcare Provider Details

I. General information

NPI: 1144606070
Provider Name (Legal Business Name): TINA SEXTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2015
Last Update Date: 08/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12005 E 470 RD
CLAREMORE OK
74017-3737
US

IV. Provider business mailing address

9232 E SHADY LN
CLAREMORE OK
74019-0804
US

V. Phone/Fax

Practice location:
  • Phone: 918-342-0770
  • Fax: 918-342-0087
Mailing address:
  • Phone: 918-804-6825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: