Healthcare Provider Details

I. General information

NPI: 1497138515
Provider Name (Legal Business Name): KELLY RANDERMANN APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2122 HIGHWAY 71 S STE 101
COLUMBUS TX
78934-3011
US

IV. Provider business mailing address

2122 HIGHWAY 71 S STE 101
COLUMBUS TX
78934-3011
US

V. Phone/Fax

Practice location:
  • Phone: 979-732-2318
  • Fax: 979-733-8757
Mailing address:
  • Phone: 979-732-2318
  • Fax: 979-733-8757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP128474
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: