Provider Demographics
NPI:1780020552
Name:RANDOLPH, KENYA NICOLE
Entity Type:Individual
Prefix:
First Name:KENYA
Middle Name:NICOLE
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7359 IRVING SCOTT DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-1058
Mailing Address - Country:US
Mailing Address - Phone:904-781-0600
Mailing Address - Fax:904-781-0016
Practice Address - Street 1:7359 IRVING SCOTT DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-1058
Practice Address - Country:US
Practice Address - Phone:904-781-0600
Practice Address - Fax:904-781-0016
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker