Provider Demographics
NPI:1629402896
Name:ACHERE, RANDIBELLA T (DNP, FNP-C)
Entity type:Individual
Prefix:
First Name:RANDIBELLA
Middle Name:T
Last Name:ACHERE
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:8417 RUSSELL DR
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089-4841
Mailing Address - Country:US
Mailing Address - Phone:469-745-4472
Mailing Address - Fax:888-571-2370
Practice Address - Street 1:630 N HIGHWAY 67
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2156
Practice Address - Country:US
Practice Address - Phone:469-745-4472
Practice Address - Fax:888-571-2370
Is Sole Proprietor?:No
Enumeration Date:2013-08-23
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP123717363L00000X, 363LF0000X
FLAPRN11017600363LP0200X, 363L00000X
TX760452363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX350515YV7AMedicare PIN