Healthcare Provider Details

I. General information

NPI: 1891909354
Provider Name (Legal Business Name): JOANN K RANDOLPH PHD, FNP, MS, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 09/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4027 EASTERN AVE
CINCINNATI OH
45226-1747
US

IV. Provider business mailing address

2415 AUBURN AVE
CINCINNATI OH
45219-2701
US

V. Phone/Fax

Practice location:
  • Phone: 513-321-2202
  • Fax:
Mailing address:
  • Phone: 513-221-4949
  • Fax: 513-241-4191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP-09144
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP-09144
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: