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NPI Code Detail

MEDICARE: MS. MARY ELIZABETH RANDLE P.A.

MEDICARE:  MS. MARY ELIZABETH RANDLE  P.A.
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
1363A00000XPhysician AssistantPA01806TX

General Provider Information

NPI Number : 1912203738
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARY ELIZABETH RANDLE P.A.
Provider Business Mailing Address
First Line : 2904 TRIMMIER RD
Second Line : PLAZA DEL SOL, SUITE 2
City : KILLEEN
State : TX
Zip : 76542-6038
Country : US
Telephone Number : 254-247-0460
Fax Number : 254-245-8899
Provider Business Practice Location Address
First Line : 2904 TRIMMIER RD
Second Line : PLAZA DEL SOL, SUITE 2
City : KILLEEN
State : TX
Zip : 76542-6038
Country : US
Telephone Number : 254-247-0460
Fax Number : 254-245-8899
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2011
Last Update Date : 04/12/2026

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Directions to “ MS. MARY ELIZABETH RANDLE P.A.” Practice Location

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