Provider Demographics
NPI:1821742560
Name:RANDALL, KEOKUK LAURA
Entity Type:Individual
Prefix:
First Name:KEOKUK
Middle Name:LAURA
Last Name:RANDALL
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 1:7505 GLENVIEW DR
Mailing Address - Street 2:
Mailing Address - City:RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-8335
Mailing Address - Country:US
Mailing Address - Phone:682-313-6404
Mailing Address - Fax:
Practice Address - Street 1:7505 GLENVIEW DR STE 1
Practice Address - Street 2:
Practice Address - City:RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-8335
Practice Address - Country:US
Practice Address - Phone:682-313-6404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX794170163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool