Healthcare Provider Details

I. General information

NPI: 1205438082
Provider Name (Legal Business Name): RANDI DEL CORAY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36892 MALLARD RD
KENAI AK
99611-6434
US

IV. Provider business mailing address

PO BOX 759
SOLDOTNA AK
99669-0759
US

V. Phone/Fax

Practice location:
  • Phone: 717-408-6075
  • Fax:
Mailing address:
  • Phone: 907-252-2419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number166543
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: