Healthcare Provider Details

I. General information

NPI: 1902684475
Provider Name (Legal Business Name): RANDI COUNTRYMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

829 RIVERBEND DR
GADSDEN AL
35901-2556
US

IV. Provider business mailing address

21908 US HIGHWAY 11
STEELE AL
35987-3077
US

V. Phone/Fax

Practice location:
  • Phone: 256-546-4611
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1-190173
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: