Provider Demographics
NPI:1932533445
Name:RANDALL, KYLE WILLIAM (CNP)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:WILLIAM
Last Name:RANDALL
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W 1325 N STE 200
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84721-8179
Mailing Address - Country:US
Mailing Address - Phone:435-586-7676
Mailing Address - Fax:
Practice Address - Street 1:110 W 1325 N STE 200
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721-8179
Practice Address - Country:US
Practice Address - Phone:435-586-7676
Practice Address - Fax:435-586-2290
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-02222363L00000X
UT7013011-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner