Provider Demographics
NPI:1750058392
Name:GUTHRIE, RANDY
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:GUTHRIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 PEA RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-9423
Mailing Address - Country:US
Mailing Address - Phone:304-237-2310
Mailing Address - Fax:
Practice Address - Street 1:608 PEA RIDGE RD
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901-9423
Practice Address - Country:US
Practice Address - Phone:304-237-2310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker