Healthcare Provider Details

I. General information

NPI: 1578786901
Provider Name (Legal Business Name): SARAH YOUNG SEXTON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH SIMONS FRASER

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 06/22/2021
Certification Date: 06/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PATEWOOD DR SUITE A200
GREENVILLE SC
29615-3593
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-454-5115
  • Fax: 864-454-5141
Mailing address:
  • Phone: 864-522-2286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2667
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: