1912155037 NPI number — MRS. SAMANTHA JO SEXTON PA-C

Table of content: MRS. SAMANTHA JO SEXTON PA-C (NPI 1912155037)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912155037 NPI number — MRS. SAMANTHA JO SEXTON PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEXTON
Provider First Name:
SAMANTHA
Provider Middle Name:
JO
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOWELL
Provider Other First Name:
SAMANTHA
Provider Other Middle Name:
JO
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912155037
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1218 S BROADWAY
Provider Second Line Business Mailing Address:
SUITE 310
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40504-2759
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-219-0542
Provider Business Mailing Address Fax Number:
859-219-9433

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1218 S BROADWAY
Provider Second Line Business Practice Location Address:
SUITE 310
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40504-2759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-219-0542
Provider Business Practice Location Address Fax Number:
859-219-9433
Provider Enumeration Date:
09/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA1154 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7100061200 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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