Provider Demographics
NPI:1932426079
Name:SEXSON, CASSANDRA MARIE (PA)
Entity Type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:MARIE
Last Name:SEXSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 AIRPORT PKWY
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1085
Mailing Address - Country:US
Mailing Address - Phone:317-926-3739
Mailing Address - Fax:317-931-3949
Practice Address - Street 1:875 AIRPORT PKWY
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1085
Practice Address - Country:US
Practice Address - Phone:317-926-3739
Practice Address - Fax:317-931-3949
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001178A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000670557OtherANTHEM
INM400040307Medicare PIN
IN000000670557OtherANTHEM