Provider Demographics
NPI:1053500900
Name:BRUMFIELD, RANDA NELL (APRN)
Entity Type:Individual
Prefix:MRS
First Name:RANDA
Middle Name:NELL
Last Name:BRUMFIELD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:RANDA
Other - Middle Name:NELL
Other - Last Name:GRACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:480 HOPKINSVILLE ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42345-1124
Mailing Address - Country:US
Mailing Address - Phone:270-338-5777
Mailing Address - Fax:270-338-5765
Practice Address - Street 1:504 HOPKINSVILLE ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:KY
Practice Address - Zip Code:42345-1104
Practice Address - Country:US
Practice Address - Phone:270-338-6488
Practice Address - Fax:270-338-7868
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1090068163WG0000X
KY3005314363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100057050Medicaid
KYK029540Medicare PIN
KYK029541Medicare PIN
KYK029542Medicare PIN