Provider Demographics
NPI:1790927754
Name:RANDLE, CYNTHIA ELAINE (WHNP)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:ELAINE
Last Name:RANDLE
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10164 BUFFALO GROVE RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-3734
Mailing Address - Country:US
Mailing Address - Phone:817-896-8169
Mailing Address - Fax:817-246-6952
Practice Address - Street 1:10164 BUFFALO GROVE RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76108-3734
Practice Address - Country:US
Practice Address - Phone:817-896-8169
Practice Address - Fax:817-246-6952
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX578237363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology