Healthcare Provider Details

I. General information

NPI: 1053645812
Provider Name (Legal Business Name): ROCHELLE MARIE SEXTON I M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2009
Last Update Date: 08/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 WATERS EDGE DR SUITE 101
GRANBURY TX
76048-1232
US

IV. Provider business mailing address

1202 DELMARVA CT
GRANBURY TX
76048-4372
US

V. Phone/Fax

Practice location:
  • Phone: 817-408-3600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP6913
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberP6913
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: