Provider Demographics
NPI:1467460279
Name:KARR, RANDY (CRNA)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:KARR
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1385 FORDHAM DR STE 105305
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-5345
Mailing Address - Country:US
Mailing Address - Phone:757-582-1899
Mailing Address - Fax:
Practice Address - Street 1:1385 FORDHAM DR STE 105305
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-5345
Practice Address - Country:US
Practice Address - Phone:757-582-1899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA24074931367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009559108Medicaid
430001144Medicare ID - Type Unspecified
VA009559108Medicaid