Healthcare Provider Details

I. General information

NPI: 1689664104
Provider Name (Legal Business Name): ZELMA KATHERINE RANDALL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ZELMA KATHERINE DICHARRY RN

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 05/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11990 JACKSON ST
CLINTON LA
70722-3210
US

IV. Provider business mailing address

P. O. BOX 395
CLINTON LA
70722-3210
US

V. Phone/Fax

Practice location:
  • Phone: 225-968-5292
  • Fax: 225-683-3411
Mailing address:
  • Phone: 225-968-5292
  • Fax: 225-683-3411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number325141986
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: