Provider Demographics
NPI:1578153391
Name:HATTON, RANDI HALL (CRNP)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:HALL
Last Name:HATTON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 MITT LARY RD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35475-4978
Mailing Address - Country:US
Mailing Address - Phone:205-246-2491
Mailing Address - Fax:
Practice Address - Street 1:1116 MITT LARY RD
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35475-4978
Practice Address - Country:US
Practice Address - Phone:205-556-5634
Practice Address - Fax:205-556-5644
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-111949363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL7069355OtherDRIVER'S LICENSE