Provider Demographics
NPI:1770582256
Name:SALMON, RANDIE R (FNP)
Entity type:Individual
Prefix:MRS
First Name:RANDIE
Middle Name:R
Last Name:SALMON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:427 GUY PARK AVE
Mailing Address - Street 2:ST. MARY'S HEALTHCARE
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-1054
Mailing Address - Country:US
Mailing Address - Phone:518-841-7430
Mailing Address - Fax:518-841-7121
Practice Address - Street 1:700 S PERRY ST
Practice Address - Street 2:JOHNSTOWN HEALTH CENTER
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095-3213
Practice Address - Country:US
Practice Address - Phone:518-762-3161
Practice Address - Fax:518-762-4902
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332395-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY141347719OtherBCBS U/W
NY490811002OtherB/S
NY02328536Medicaid
NY141347719OtherBCBS U/W
NY02328536Medicaid