Healthcare Provider Details

I. General information

NPI: 1134660905
Provider Name (Legal Business Name): RYAN HANSEN SEXTON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2017
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 4TH ST
LONGVIEW TX
75605-5128
US

IV. Provider business mailing address

3401 US HIGHWAY 259 N APT 837
LONGVIEW TX
75605-8066
US

V. Phone/Fax

Practice location:
  • Phone: 903-232-3600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN135524
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number808440
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: