Provider Demographics
NPI:1639946254
Name:RANDALL, JAMES JR (BSN)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:RANDALL
Suffix:JR
Gender:M
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6769 N PARK CIR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71107-9128
Mailing Address - Country:US
Mailing Address - Phone:318-470-8044
Mailing Address - Fax:
Practice Address - Street 1:6769 N PARK CIR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71107-9128
Practice Address - Country:US
Practice Address - Phone:318-470-8044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)