Provider Demographics
NPI:1811544299
Name:RANDOLPH, KATHRAN F (MED)
Entity Type:Individual
Prefix:MRS
First Name:KATHRAN
Middle Name:F
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5850 FLORIDA BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-4247
Mailing Address - Country:US
Mailing Address - Phone:225-201-0696
Mailing Address - Fax:
Practice Address - Street 1:5850 FLORIDA BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-4247
Practice Address - Country:US
Practice Address - Phone:225-201-0696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician