Provider Demographics
NPI:1346869831
Name:SEXTON, BRENDON D
Entity Type:Individual
Prefix:
First Name:BRENDON
Middle Name:D
Last Name:SEXTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61104 S 4647 RD
Mailing Address - Street 2:
Mailing Address - City:WATTS
Mailing Address - State:OK
Mailing Address - Zip Code:74964-1189
Mailing Address - Country:US
Mailing Address - Phone:918-226-0063
Mailing Address - Fax:
Practice Address - Street 1:61104 S 4647 RD
Practice Address - Street 2:
Practice Address - City:WATTS
Practice Address - State:OK
Practice Address - Zip Code:74964-1189
Practice Address - Country:US
Practice Address - Phone:918-226-0063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist