Provider Demographics
NPI:1245552652
Name:ROBERTS, RANDI JO (BA, MHPP)
Entity type:Individual
Prefix:
First Name:RANDI
Middle Name:JO
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:BA, MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15968
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72231-5968
Mailing Address - Country:US
Mailing Address - Phone:501-221-1843
Mailing Address - Fax:501-221-2376
Practice Address - Street 1:201 W. SECOND ST.
Practice Address - Street 2:
Practice Address - City:LONOKE
Practice Address - State:AR
Practice Address - Zip Code:72086
Practice Address - Country:US
Practice Address - Phone:501-676-3151
Practice Address - Fax:501-676-3152
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator