Provider Demographics
NPI:1396849980
Name:SEXTON, LARRY CLIFFORD (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:CLIFFORD
Last Name:SEXTON
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:NOBLEBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04555
Mailing Address - Country:US
Mailing Address - Phone:207-453-4708
Mailing Address - Fax:207-453-6250
Practice Address - Street 1:841 RIVERSIDE DR.
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330
Practice Address - Country:US
Practice Address - Phone:207-213-4616
Practice Address - Fax:207-213-4727
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER049009363LP0808X
MEAP101014363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432079799Medicaid