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General NPI Number Information
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NPI Number | 1356781819
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Entity Type | Individual
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Provider Name | RANDAL HERBERT FNP-C
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Gender | Male
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Dates
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Enumeration Date | 06/28/2013
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Last Update Date | 10/25/2019
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Provider Practice Location Address
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Address Line | 14116 CUSTOMS BLVD
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City | GULFPORT
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State | MS
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Zip | 39503-5164
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Country | US
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Telephone | 601-957-6300
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Fax |
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Provider Business Mailing Address
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Address Line | 4200 IOLA ST.
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City | METAIRIE
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State | LA
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Zip | 70001
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Country | US
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Telephone | 504-296-0777
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Fax | 504-455-2992
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F0613731
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License Number State | LA
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