Provider Demographics
NPI:1912203738
Name:RANDLE, MARY ELIZABETH (PA)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELIZABETH
Last Name:RANDLE
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Gender:F
Credentials:PA
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Mailing Address - Street 1:2904 TRIMMIER RD
Mailing Address - Street 2:PLAZA DEL SOL, SUITE 2
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-6038
Mailing Address - Country:US
Mailing Address - Phone:254-247-0460
Mailing Address - Fax:254-245-8899
Practice Address - Street 1:2904 TRIMMIER RD
Practice Address - Street 2:PLAZA DEL SOL, SUITE 2
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-6038
Practice Address - Country:US
Practice Address - Phone:254-247-0460
Practice Address - Fax:254-245-8899
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
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Provider Licenses
StateLicense IDTaxonomies
TXPA01806363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant