Healthcare Provider Details

I. General information

NPI: 1104542109
Provider Name (Legal Business Name): RANDY PAUL GOLEMAN ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E SELTICE WAY STE 204
POST FALLS ID
83854-7638
US

IV. Provider business mailing address

601 E SELTICE WAY STE 204
POST FALLS ID
83854-7638
US

V. Phone/Fax

Practice location:
  • Phone: 208-444-9820
  • Fax:
Mailing address:
  • Phone: 208-444-9820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberTEMP58976
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1112901
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN-3981
License Number StateHI
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61409196
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number865047
License Number StateNV
# 6
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number58976
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: