Provider Demographics
NPI:1093225104
Name:SEXTON, RICKIE
Entity Type:Individual
Prefix:
First Name:RICKIE
Middle Name:
Last Name:SEXTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2091 DORCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:VA
Mailing Address - Zip Code:24273-4414
Mailing Address - Country:US
Mailing Address - Phone:276-791-2031
Mailing Address - Fax:
Practice Address - Street 1:2091 DORCHESTER RD
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-4414
Practice Address - Country:US
Practice Address - Phone:276-791-2031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver