Basic Information
| Provider Information | |||||||||
| NPI: | 1396849980 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SEXTON | ||||||||
| FirstName: | LARRY | ||||||||
| MiddleName: | CLIFFORD | ||||||||
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| Credential: | PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 157 | ||||||||
| Address2: | |||||||||
| City: | NOBLEBORO | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074534708 | ||||||||
| FaxNumber: | 2074536250 | ||||||||
| Practice Location | |||||||||
| Address1: | 841 RIVERSIDE DR. | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2072134616 | ||||||||
| FaxNumber: | 2072134727 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2006 | ||||||||
| LastUpdateDate: | 12/04/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | R049009 | ME | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363LP0808X | AP101014 | ME | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 432079799 | 05 | ME | MEDICAID |