Provider Demographics
NPI:1235482001
Name:RANDOLPH, LYNDSEY RENEE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:LYNDSEY
Middle Name:RENEE
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 MEMORIAL DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-8668
Mailing Address - Country:US
Mailing Address - Phone:706-277-7311
Mailing Address - Fax:
Practice Address - Street 1:1107 MEMORIAL DR
Practice Address - Street 2:SUITE 201
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8668
Practice Address - Country:US
Practice Address - Phone:706-277-7311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16721363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily