Healthcare Provider Details

I. General information

NPI: 1215210943
Provider Name (Legal Business Name): RANDALL BLAKE BIBLE NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 COOLIDGE ST SUITE 3
GREENEVILLE TN
37743-4672
US

IV. Provider business mailing address

1021 COOLIDGE ST SUITE 3
GREENEVILLE TN
37743-4672
US

V. Phone/Fax

Practice location:
  • Phone: 423-636-0702
  • Fax: 423-636-0709
Mailing address:
  • Phone: 423-636-0702
  • Fax: 423-636-0709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN16106
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN16106
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: