Healthcare Provider Details

I. General information

NPI: 1659645646
Provider Name (Legal Business Name): JESSICA LEE SEXTON APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2012
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 WAYNE RD
SAVANNAH TN
38372-5148
US

IV. Provider business mailing address

1860 WAYNE RD
SAVANNAH TN
38372-5148
US

V. Phone/Fax

Practice location:
  • Phone: 931-722-3448
  • Fax: 931-722-9919
Mailing address:
  • Phone: 931-722-3448
  • Fax: 931-722-9919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN16549
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: