Healthcare Provider Details

I. General information

NPI: 1578302527
Provider Name (Legal Business Name): CHRISTOPHER TATE SEXTON PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 CAPITAL MALL DR SW STE 200
OLYMPIA WA
98502-8701
US

IV. Provider business mailing address

3920 CAPITAL MALL DR SW STE 200
OLYMPIA WA
98502-8701
US

V. Phone/Fax

Practice location:
  • Phone: 360-706-6400
  • Fax: 360-596-4889
Mailing address:
  • Phone: 360-706-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61604447
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: