Basic Information
| Provider Information | |||||||||
| NPI: | 1437152279 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SEXTON | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | AU.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2605 KENTUCKY AVE | ||||||||
| Address2: | DOB 3, SUITE 601 | ||||||||
| City: | PADUCAH | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420033800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2704084368 | ||||||||
| FaxNumber: | 2704083272 | ||||||||
| Practice Location | |||||||||
| Address1: | 2605 KENTUCKY AVE | ||||||||
| Address2: | DOB 3, SUITE 601 | ||||||||
| City: | PADUCAH | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420033800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2704084368 | ||||||||
| FaxNumber: | 2704083272 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2005 | ||||||||
| LastUpdateDate: | 06/16/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 0449 | KY | N | Speech, Language and Hearing Service Providers | Audiologist | 237700000X | 0632 | KY | N | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist | 237600000X | KY-0449 | KY | Y | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 231H00000X | KY-0917 | KY | N | Speech, Language and Hearing Service Providers | Audiologist | 237700000X | N | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
ID Information
| ID | Type | State | Issuer | Description | 000000614199 | 01 | KY | KY BCBS | OTHER | 1437152279 | 01 | KY | NPI | OTHER | 70001227 | 05 | KY | MEDICAID |