Provider Demographics
NPI:1801396049
Name:SISSON, PAXTON KIMBER (PA)
Entity Type:Individual
Prefix:MS
First Name:PAXTON
Middle Name:KIMBER
Last Name:SISSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1720 EAST REELFOOT AVE.
Mailing Address - Street 2:SUITE 104
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-6048
Mailing Address - Country:US
Mailing Address - Phone:731-885-8484
Mailing Address - Fax:731-884-1609
Practice Address - Street 1:1720 EAST REELFOOT AVENUE
Practice Address - Street 2:SUITE 104
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261
Practice Address - Country:US
Practice Address - Phone:731-885-8484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-14
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3514363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant