Provider Demographics
NPI:1013212943
Name:RANDLES, CLAY (PA-C)
Entity type:Individual
Prefix:MR
First Name:CLAY
Middle Name:
Last Name:RANDLES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 E WILLAMETTE AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1132
Mailing Address - Country:US
Mailing Address - Phone:719-344-9650
Mailing Address - Fax:
Practice Address - Street 1:28 E WILLAMETTE AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1132
Practice Address - Country:US
Practice Address - Phone:719-344-9650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-25
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA16748363A00000X
NC0010-15518363A00000X
IA135373363A00000X
COPA.0005303363A00000X
AZ10257363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant