Provider Demographics
NPI:1497705396
Name:BECKETT, RANDALL H (DNP, DC, APRN, NP-C)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:H
Last Name:BECKETT
Suffix:
Gender:M
Credentials:DNP, DC, APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1433 WELLESLEY CIR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-9047
Mailing Address - Country:US
Mailing Address - Phone:843-412-3042
Mailing Address - Fax:803-335-5151
Practice Address - Street 1:1433 WELLESLEY CIR
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-9047
Practice Address - Country:US
Practice Address - Phone:843-412-3042
Practice Address - Fax:803-335-5151
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2015-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0905111N00000X
SCF2945363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAA136003OtherSTATE LICENSE APRN FAMILY NURSE PRACTITIONER
NENA2327003OtherMEDICARE PTAN
SC2945OtherSOUTH BOARD OF NURSING LICENSE
IAIB3119001OtherMEDICARE PTAN
SCAA72480281OtherMEDICARE PTAN
NE111635OtherSTATE LICENSE APRN
IAG136033OtherSTATE LICENSE APRN PSYCH/MENTAL HEALTH