Provider Demographics
NPI:1265943765
Name:RANDALL, REBEKAH LYNNE (CNM)
Entity type:Individual
Prefix:MRS
First Name:REBEKAH
Middle Name:LYNNE
Last Name:RANDALL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:LYNNE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4100 DUVAL RD BLDG 2 SUITE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-3456
Mailing Address - Country:US
Mailing Address - Phone:512-346-3224
Mailing Address - Fax:
Practice Address - Street 1:4100 DUVAL RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-3456
Practice Address - Country:US
Practice Address - Phone:512-346-3224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX730024163W00000X
TXAP135396367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse