Provider Demographics
NPI:1467282491
Name:SEXTON-AMIS, SHEREE (JD)
Entity type:Individual
Prefix:
First Name:SHEREE
Middle Name:
Last Name:SEXTON-AMIS
Suffix:
Gender:F
Credentials:JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 CRIPPLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-7126
Mailing Address - Country:US
Mailing Address - Phone:606-438-2166
Mailing Address - Fax:
Practice Address - Street 1:704 CRIPPLE CREEK DR
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-7126
Practice Address - Country:US
Practice Address - Phone:606-438-2166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities