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General NPI Number Information
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NPI Number | 1164547071
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Entity Type | Individual
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Provider Name | SANDRA MCKNIGHT RANDOLPH NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 02/09/2026
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Provider Practice Location Address
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Address Line | 4100 N MAIN ST STE 201
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City | COLUMBIA
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State | SC
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Zip | 29203-5800
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Country | US
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Telephone | 803-814-2112
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Fax |
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Provider Business Mailing Address
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Address Line | 144 TANNOCK CT
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City | LEXINGTON
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State | SC
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Zip | 29072-7967
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Country | US
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Telephone | 803-996-0614
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APN840
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN840
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License Number State | SC
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