Provider Demographics
NPI:1184673626
Name:SEXTON, SHAWNA M (DO)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:M
Last Name:SEXTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 HOSPITAL ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:KY
Mailing Address - Zip Code:42633-2416
Mailing Address - Country:US
Mailing Address - Phone:606-340-3251
Mailing Address - Fax:606-348-0618
Practice Address - Street 1:166 HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633-2416
Practice Address - Country:US
Practice Address - Phone:606-340-3251
Practice Address - Fax:606-348-0618
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03246207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000653221OtherANTHEM BC & BS
KY03246OtherLICENSE
KY7100104900Medicaid
KY3334435Medicare PIN