Provider Demographics
NPI:1235877317
Name:MORRIS, RANDI LYNN (FNP)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:LYNN
Last Name:MORRIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5358 N CORD DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-4309
Mailing Address - Country:US
Mailing Address - Phone:928-848-3190
Mailing Address - Fax:
Practice Address - Street 1:3128 N TANI RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-8610
Practice Address - Country:US
Practice Address - Phone:928-848-3190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-26
Last Update Date:2022-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ275447363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ275447OtherARIZONA BOARD OF NURSING