Provider Demographics
NPI:1770039000
Name:RANDLE, DANIEL
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:RANDLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 PARKWAY TERRACE
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-4761
Mailing Address - Country:US
Mailing Address - Phone:972-291-0805
Mailing Address - Fax:
Practice Address - Street 1:1003 PARKWAY TERRACE
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-4761
Practice Address - Country:US
Practice Address - Phone:972-291-0805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX017944374U00000X, 251E00000X, 251E00000X, 405300000X, 374U00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No405300000XOther Service ProvidersPrevention Professional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX017944Medicaid
TX017944OtherPERSONAL ASSISTANCE SERVICE