Provider Demographics
NPI:1720229875
Name:LANTRIP, JAMES RANDEL (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:RANDEL
Last Name:LANTRIP
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:273 CEDAR LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-7138
Mailing Address - Country:US
Mailing Address - Phone:325-439-9887
Mailing Address - Fax:
Practice Address - Street 1:2125 PINE ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2435
Practice Address - Country:US
Practice Address - Phone:325-672-5201
Practice Address - Fax:325-677-3531
Is Sole Proprietor?:No
Enumeration Date:2009-03-19
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX716255363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2205635Medicaid
TX292094YSPKMedicare PIN