Provider Demographics
NPI:1295012813
Name:RANDALL, RAINA BURLEIGH (WHNP-BC)
Entity Type:Individual
Prefix:
First Name:RAINA
Middle Name:BURLEIGH
Last Name:RANDALL
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:RAINA
Other - Middle Name:DERRELLE
Other - Last Name:BURLEIGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WHNP-BC
Mailing Address - Street 1:4600 GULF FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77023-3548
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13169 NORTHWEST FWY
Practice Address - Street 2:STE. 115
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77040
Practice Address - Country:US
Practice Address - Phone:713-514-1107
Practice Address - Fax:404-494-7435
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX671971163W00000X
TXAP119571363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2875122-03Medicaid
TX2875122-02Medicaid