Provider Demographics
NPI:1982606455
Name:BUMPERS, RANDY DARRELL (NP-C)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:DARRELL
Last Name:BUMPERS
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 LANCASTER CT
Mailing Address - Street 2:
Mailing Address - City:CALERA
Mailing Address - State:AL
Mailing Address - Zip Code:35040-4702
Mailing Address - Country:US
Mailing Address - Phone:205-668-3346
Mailing Address - Fax:205-668-3346
Practice Address - Street 1:3001 27TH ST N
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35207-4549
Practice Address - Country:US
Practice Address - Phone:205-502-5808
Practice Address - Fax:205-502-5820
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-054440363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily