=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235081654
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANTIONETTE RANDALL LPN, PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2026
-----------------------------------------------------
Last Update Date | 02/10/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 407 ONTARIO AVE
-----------------------------------------------------
City | DUSON
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70529
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-909-5241
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 OLD SILO RD
-----------------------------------------------------
City | RAYNE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70578-2550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-909-9524
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------