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General NPI Number Information
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NPI Number | 1295100808
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Entity Type | Individual
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Provider Name | LAUREN ASHLEY SEXTON ATC
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Gender | Female
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Dates
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Enumeration Date | 12/08/2015
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Last Update Date | 09/24/2018
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Provider Practice Location Address
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Address Line | 1747 IMPERIAL BLVD
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City | LAKE CHARLES
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State | LA
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Zip | 70605-5362
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Country | US
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Telephone | 479-719-3201
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Fax |
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Provider Business Mailing Address
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Address Line | 420 NORTH MAIN STREET
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City | GREENWOOD
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State | AR
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Zip | 72936
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Country | US
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Telephone | 479-252-6370
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | ATH.200254
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License Number State | LA
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