Healthcare Provider Details

I. General information

NPI: 1982606455
Provider Name (Legal Business Name): RANDY DARRELL BUMPERS NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 27TH ST N
BIRMINGHAM AL
35207-4549
US

IV. Provider business mailing address

56 LANCASTER CT
CALERA AL
35040-4702
US

V. Phone/Fax

Practice location:
  • Phone: 205-502-5808
  • Fax: 205-502-5820
Mailing address:
  • Phone: 205-668-3346
  • Fax: 205-668-3346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-054440
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: