Provider Demographics
NPI:1609020528
Name:SEXTON, JAMIE M (RDE MED)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:M
Last Name:SEXTON
Suffix:
Gender:F
Credentials:RDE MED
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:M
Other - Last Name:PRATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:828 WATSON RD
Mailing Address - Street 2:
Mailing Address - City:BIDWELL
Mailing Address - State:OH
Mailing Address - Zip Code:45614-9580
Mailing Address - Country:US
Mailing Address - Phone:740-441-1350
Mailing Address - Fax:
Practice Address - Street 1:828 WATSON RD
Practice Address - Street 2:
Practice Address - City:BIDWELL
Practice Address - State:OH
Practice Address - Zip Code:45614-9580
Practice Address - Country:US
Practice Address - Phone:740-441-1350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
WV728133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered