Provider Demographics
NPI:1316049497
Name:SEXTON, THERESA MARY (APRN)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:MARY
Last Name:SEXTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TERRY
Other - Middle Name:MARY
Other - Last Name:SEXTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:142 MILESTONE WAY
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-5065
Mailing Address - Country:US
Mailing Address - Phone:864-558-0092
Mailing Address - Fax:855-269-6611
Practice Address - Street 1:142 MILESTONE WAY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-5065
Practice Address - Country:US
Practice Address - Phone:864-558-0092
Practice Address - Fax:855-269-6611
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN19435363LF0000X
FLARNP1755352363LP0200X
SC19435363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP4377Medicaid
FL305312100Medicaid
FL308333100Medicaid