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General NPI Number Information
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NPI Number | 1891980728
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Entity Type | Individual
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Provider Name | CARRIE LINDA RANDALL P.A.-C
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Gender | Female
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Dates
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Enumeration Date | 09/13/2007
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Last Update Date | 06/26/2015
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Provider Practice Location Address
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Address Line | 1505 E MAIN ST STIGLER HEALTH AND WELLNESS
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City | STIGLER
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State | OK
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Zip | 74462-2913
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Country | US
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Telephone | 918-967-3368
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Fax | 918-967-3351
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Provider Business Mailing Address
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Address Line | 2525 CHANDLER RD
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City | MUSKOGEE
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State | OK
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Zip | 74403-5088
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Country | US
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Telephone | 918-681-7533
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Fax | 918-684-9033
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1077570
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License Number State | OK
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