Healthcare Provider Details

I. General information

NPI: 1053656447
Provider Name (Legal Business Name): MERCEDES RANDOLPH PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2012
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4575 BYRD DR
LOVELAND CO
80538-7198
US

IV. Provider business mailing address

4575 BYRD DR
LOVELAND CO
80538-7198
US

V. Phone/Fax

Practice location:
  • Phone: 970-593-3300
  • Fax:
Mailing address:
  • Phone: 970-593-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0999251-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number824676
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: