Provider Demographics
NPI:1821054669
Name:EARLS, RANDY A (APN)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:A
Last Name:EARLS
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:131 SAUNDERSVILLE RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-8903
Mailing Address - Country:US
Mailing Address - Phone:901-203-2901
Mailing Address - Fax:901-779-6968
Practice Address - Street 1:700 SHERRILL ST
Practice Address - Street 2:SUITE B
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-5891
Practice Address - Country:US
Practice Address - Phone:731-884-3900
Practice Address - Fax:731-884-3901
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2016-07-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN11065363LA2200X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q47291OtherUPIN
TNQ013847Medicaid
TNQ013847Medicaid
TN4144773OtherBCBS