Provider Demographics
NPI:1730662982
Name:KENT, RANDI L (PA-C)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:L
Last Name:KENT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RANDI
Other - Middle Name:L
Other - Last Name:FABSITS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 POINT PL STE 200
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-2836
Mailing Address - Country:US
Mailing Address - Phone:608-820-2381
Mailing Address - Fax:608-203-9288
Practice Address - Street 1:1 POINT PL STE 200
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-2836
Practice Address - Country:US
Practice Address - Phone:608-820-2381
Practice Address - Fax:608-203-9288
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
WI5541-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical