Provider Demographics
NPI:1245562800
Name:RANDALL, LAKEIDRIA (CRNA)
Entity type:Individual
Prefix:
First Name:LAKEIDRIA
Middle Name:
Last Name:RANDALL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LAKEIDRIA
Other - Middle Name:
Other - Last Name:RANDALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:7777 HENNESSY BLVD
Mailing Address - Street 2:STE. 301
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4300
Mailing Address - Country:US
Mailing Address - Phone:214-592-2957
Mailing Address - Fax:225-214-6437
Practice Address - Street 1:7777 HENNESSY BLVD
Practice Address - Street 2:STE. 301
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4300
Practice Address - Country:US
Practice Address - Phone:214-592-2957
Practice Address - Fax:225-214-6437
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA112518163WA2000X
LAAP07633367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2353403Medicaid
LA2353403Medicaid