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General NPI Number Information
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NPI Number | 1922546464
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Entity Type | Individual
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Provider Name | ALYSSA M RANDOLPH FNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/04/2017
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 10590 N MERIDIAN ST
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City | CARMEL
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State | IN
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Zip | 46290-1028
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Country | US
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Telephone | 317-338-6666
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Fax | 317-338-6066
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Provider Business Mailing Address
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Address Line | 5510 S EAST ST STE H
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City | INDIANAPOLIS
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State | IN
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Zip | 46227-1939
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Country | US
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Telephone | 317-924-8425
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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 | 71007267A
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License Number State | IN
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