Provider Demographics
NPI:1457346108
Name:OBRIEN, RANDI K (ARNP)
Entity type:Individual
Prefix:MRS
First Name:RANDI
Middle Name:K
Last Name:OBRIEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 W MALLON AVE STE 503
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2181
Mailing Address - Country:US
Mailing Address - Phone:509-455-5546
Mailing Address - Fax:509-455-5201
Practice Address - Street 1:621 W MALLON AVE STE 503
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2181
Practice Address - Country:US
Practice Address - Phone:509-455-5546
Practice Address - Fax:509-455-5201
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006159363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9637331Medicaid
WA9637331Medicaid
P73548Medicare UPIN