MEDICARE: JENNIFER MAE SEXTON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	MD60167314	WA
2	2084P0800X	Psychiatry Physician	107980	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0264804	OTHER	WA	L&I

General Provider Information

NPI Number	:	1467556027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MAE SEXTON MD

Provider Business Mailing Address
First Line	:	3800 PARK NICOLLET BLVD
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55416-2527
Country	:	US
Telephone Number	:	952-993-3307
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 PARK NICOLLET BLVD
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55416-2527
Country	:	US
Telephone Number	:	952-993-3307
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	12/01/2014

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