Basic Information
| Provider Information | |||||||||
| NPI: | 1619600079 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEXTON | ||||||||
| FirstName: | TAMMY | ||||||||
| MiddleName: | JEAN | ||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3342 BIG RUN RD | ||||||||
| Address2: | |||||||||
| City: | LUCASVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456488910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7408215576 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 840 GALLIA ST | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456624232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403533236 | ||||||||
| FaxNumber: | 7403534803 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2022 | ||||||||
| LastUpdateDate: | 07/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | LPN.145765.MEDS-IV | OH | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.