Provider Demographics
NPI:1326198177
Name:RANDALL, JANE ARLENE (PNP)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:ARLENE
Last Name:RANDALL
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 109
Mailing Address - Street 2:
Mailing Address - City:JARVISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27947-0109
Mailing Address - Country:US
Mailing Address - Phone:252-491-2885
Mailing Address - Fax:252-491-8699
Practice Address - Street 1:7107 CARATOKE HIGHWAY
Practice Address - Street 2:
Practice Address - City:JARVISBURG
Practice Address - State:NC
Practice Address - Zip Code:27947
Practice Address - Country:US
Practice Address - Phone:252-491-2885
Practice Address - Fax:252-491-8699
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC300157363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP81348Medicare UPIN
NC2807575AMedicare ID - Type Unspecified