Healthcare Provider Details

I. General information

NPI: 1912842956
Provider Name (Legal Business Name): CHRISTOPHER RANDOLPH APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 MARKET STREET KEISER ARKANSAS 72354
KEISER AR
72354
US

IV. Provider business mailing address

125 HOLMES ST
LEPANTO AR
72354-8800
US

V. Phone/Fax

Practice location:
  • Phone: 870-375-1263
  • Fax: 870-469-8565
Mailing address:
  • Phone: 870-375-1263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number20591
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: