Provider Demographics
NPI:1669618377
Name:JOHNS, RANDY D (CRNP)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:D
Last Name:JOHNS
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 ONEIDA VALLEY RD STE 400
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-2251
Mailing Address - Country:US
Mailing Address - Phone:866-620-6761
Mailing Address - Fax:724-282-3043
Practice Address - Street 1:127 ONEIDA VALLEY RD STE 400
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-2251
Practice Address - Country:US
Practice Address - Phone:866-620-6761
Practice Address - Fax:724-282-3043
Is Sole Proprietor?:No
Enumeration Date:2008-12-30
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008817363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP008817OtherLICENSE