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General NPI Number Information
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NPI Number | 1013212943
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Entity Type | Individual
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Provider Name | CLAY RANDLES PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/25/2011
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 28 E WILLAMETTE AVE
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City | COLORADO SPRINGS
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State | CO
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Zip | 80903-1132
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Country | US
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Telephone | 719-344-9650
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Fax |
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Provider Business Mailing Address
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Address Line | 28 E WILLAMETTE AVE
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City | COLORADO SPRINGS
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State | CO
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Zip | 80903-1132
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Country | US
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Telephone | 719-344-9650
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA16748
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-15518
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 135373
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License Number State | IA
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.0005303
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License Number State | CO
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Taxonomy #5
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10257
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License Number State | AZ
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