Healthcare Provider Details

I. General information

NPI: 1053500900
Provider Name (Legal Business Name): RANDA NELL BRUMFIELD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RANDA NELL GRACE RN

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 12/20/2019
Certification Date: 12/20/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 HOPKINSVILLE ST
GREENVILLE KY
42345-1104
US

IV. Provider business mailing address

480 HOPKINSVILLE ST
GREENVILLE KY
42345-1124
US

V. Phone/Fax

Practice location:
  • Phone: 270-338-6488
  • Fax: 270-338-7868
Mailing address:
  • Phone: 270-338-5777
  • Fax: 270-338-5765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number1090068
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3005314
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: