MRS. JUDITH MYRICK RANDALL ARNP NPI 1891978763

NPI Information

NPI: 1891978763
Provider Name: MRS. JUDITH MYRICK RANDALL, ARNP
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

PECOS Registration: Yes

Address:
1890 WAITE ST
STE 1
NORTH BEND, OR
ZIP 97459
Phone: (541) 756-6232
Get Directions

MRS. Judith Myrick Randall, ARNP is a family nurse practitioner in North Bend, OR. MRS. Judith Myrick Randall, ARNP NPI is 1891978763. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1890 WAITE ST
STE 1
NORTH BEND, OR
ZIP 97459-229
Phone: (541) 756-6232
Fax: (541) 756-6234

The NPI 1891978763 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 12/13/2007 and was last updated on 6/22/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	AP30007876	WASHINGTON	No
2	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	201250025NP	OREGON	No
3	363LF0000X	Nurse Practitioner	Family	201250024	OREGON	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	381902	MEDICARE OSCAR/CERTIFICATION
2	R120353	OTHER		GROUP PTAN NUMBER
3	R163264	MEDICARE UPIN
4	213342	MEDICAID	OREGON
5	1619915113	OTHER		WATERFALL CLINIC, INC. GROUP NPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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