Provider Demographics
NPI:1740516855
Name:GENTRY, RANDY (APRN,FNP-C)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:GENTRY
Suffix:
Gender:M
Credentials:APRN,FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7133 OCONNELL ST
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-7033
Mailing Address - Country:US
Mailing Address - Phone:469-766-1094
Mailing Address - Fax:
Practice Address - Street 1:7133 OCONNELL ST
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-7033
Practice Address - Country:US
Practice Address - Phone:469-766-1094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX651184363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner