Healthcare Provider Details

I. General information

NPI: 1689019341
Provider Name (Legal Business Name): KASSI ANN SEXTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2013
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2307 GORDON COOPER DR
SHAWNEE OK
74801-9007
US

IV. Provider business mailing address

2307 GORDON COOPER DR
SHAWNEE OK
74801-9007
US

V. Phone/Fax

Practice location:
  • Phone: 405-964-5770
  • Fax: 405-275-1620
Mailing address:
  • Phone: 402-552-2050
  • Fax: 402-552-2186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number207Q0000X
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: