COURTNEY DYAN RANDOLPH ARNP NPI 1558071597

NPI Information

NPI: 1558071597
Provider Name: COURTNEY DYAN RANDOLPH, ARNP
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

PECOS Registration: Yes

Address:
10004 204TH AVE E FL 3
BONNEY LAKE, WA
ZIP 98391
Phone: (253) 848-5951
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Courtney Dyan Randolph, ARNP is a family nurse practitioner in Bonney Lake, WA with 4 years of experience. Courtney Dyan Randolph, ARNP NPI is 1558071597. 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:

10004 204TH AVE E FL 3
BONNEY LAKE, WA
ZIP 98391-539
Phone: (253) 848-5951
Fax: (253) 845-7073

The NPI 1558071597 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 11/30/2022 and was last updated on 11/30/2022.

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	AP61372574	WASHINGTON	Yes

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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