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General NPI Number Information
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NPI Number | 1174095749
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Entity Type | Individual
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Provider Name | EMILY E RANDLE CRNA
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Gender | Female
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Dates
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Enumeration Date | 12/20/2018
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Last Update Date | 12/20/2018
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Provider Practice Location Address
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Address Line | 3900 LAKELAND DR STE 505C
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City | FLOWOOD
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State | MS
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Zip | 39232-8854
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Country | US
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Telephone | 601-936-0686
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Fax |
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Provider Business Mailing Address
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Address Line | 417 MADISON OAKS DR
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City | MADISON
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State | MS
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Zip | 39110-9495
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Country | US
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Telephone | 601-479-8333
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 122182
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License Number State | MS
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