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General NPI Number Information
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NPI Number | 1912842956
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Entity Type | Individual
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Provider Name | CHRISTOPHER RANDOLPH APRN
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Gender | Male
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Dates
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Enumeration Date | 04/23/2026
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Last Update Date | 04/23/2026
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Provider Practice Location Address
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Address Line | 209 MARKET STREET KEISER ARKANSAS 72354
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City | KEISER
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State | AR
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Zip | 72354
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Country | US
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Telephone | 870-375-1263
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Fax | 870-469-8565
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Provider Business Mailing Address
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Address Line | 125 HOLMES ST
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City | LEPANTO
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State | AR
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Zip | 72354-8800
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Country | US
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Telephone | 870-375-1263
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 20591
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License Number State | AR
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