Provider Demographics
NPI:1639626997
Name:RANDALL, ADAM LEE (DNP, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:LEE
Last Name:RANDALL
Suffix:
Gender:M
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7415 ARAIA DR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-1590
Mailing Address - Country:US
Mailing Address - Phone:863-224-2903
Mailing Address - Fax:
Practice Address - Street 1:7415 ARAIA DR
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817-1590
Practice Address - Country:US
Practice Address - Phone:863-224-2903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-04
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK114971363LF0000X
COAPN.0992741-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily