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NPI Code Detail

MEDICARE: RANDALL LYNN YORK FNP

MEDICARE: RANDALL LYNN YORK FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner640043TX

General Provider Information

NPI Number : 1740261395
Entity Type Code : Individual
Provider Name (Legal Business Name) : RANDALL LYNN YORK FNP
Provider Business Mailing Address
First Line : 1600 PROVIDENCE DR
Second Line :
City : WACO
State : TX
Zip : 76707-2261
Country : US
Telephone Number : 254-313-4200
Fax Number : 254-313-4326
Provider Business Practice Location Address
First Line : 1600 PROVIDENCE DR
Second Line :
City : WACO
State : TX
Zip : 76707-2261
Country : US
Telephone Number : 254-313-4200
Fax Number : 254-313-4531
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2005
Last Update Date : 04/26/2013

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