Healthcare Provider Details

I. General information

NPI: 1356486021
Provider Name (Legal Business Name): RANDALL SCOTT HOMER NP, PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3941 J ST SUITE 354
SACRAMENTO CA
95819-3624
US

IV. Provider business mailing address

9770 WOODHOLLOW WAY
SACRAMENTO CA
95827-2724
US

V. Phone/Fax

Practice location:
  • Phone: 916-733-6870
  • Fax:
Mailing address:
  • Phone: 916-362-5952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number19058
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number17075
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: