Healthcare Provider Details

I. General information

NPI: 1144946245
Provider Name (Legal Business Name): RANDA CORLEY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2022
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 4TH AVE SW
REFORM AL
35481-8018
US

IV. Provider business mailing address

12721 SANFORD LN
NORTHPORT AL
35473-7212
US

V. Phone/Fax

Practice location:
  • Phone: 205-375-6251
  • Fax: 205-375-9064
Mailing address:
  • Phone: 205-657-8238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number1-155905
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1-155905
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: