Healthcare Provider Details

I. General information

NPI: 1447858808
Provider Name (Legal Business Name): COURTNEY SEXTON CRNP, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2020
Last Update Date: 04/19/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 JPM RD
LEWISBURG PA
17837-9313
US

IV. Provider business mailing address

240 GHANER DR
STATE COLLEGE PA
16803-1199
US

V. Phone/Fax

Practice location:
  • Phone: 570-551-0300
  • Fax:
Mailing address:
  • Phone: 740-285-3904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN729675
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.458618
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberSP022220
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: