Healthcare Provider Details

I. General information

NPI: 1720524655
Provider Name (Legal Business Name): VICKY SEXTON CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2017
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 RAYDER AVE
LOUDON TN
37774-1050
US

IV. Provider business mailing address

600 RAYDER AVE
LOUDON TN
37774-1050
US

V. Phone/Fax

Practice location:
  • Phone: 865-458-2662
  • Fax: 865-458-8587
Mailing address:
  • Phone: 865-458-2662
  • Fax: 865-458-8587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number117053
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: