Provider Demographics
NPI:1639175854
Name:RANDOLPH, SHERRI L (APRN, BC)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:L
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5683 S REX RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3821
Mailing Address - Country:US
Mailing Address - Phone:731-507-0272
Mailing Address - Fax:615-384-9947
Practice Address - Street 1:1720 E REELFOOT AVE STE 200
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261
Practice Address - Country:US
Practice Address - Phone:731-507-0272
Practice Address - Fax:731-507-0273
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7531363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP45459Medicare UPIN
TN3909821Medicare ID - Type UnspecifiedMEDICARE