MEDICARE: MR. RANDOL BROWN ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	61087945	WA
2	363LF0000X	Family Nurse Practitioner	3017196	KY

General Provider Information

NPI Number	:	1134738172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RANDOL BROWN ARNP

Provider Business Mailing Address
First Line	:	210 MALLORY SPG
Second Line	:
City	:	BEREA
State	:	KY
Zip	:	40403-9653
Country	:	US
Telephone Number	:	859-302-0110
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 KEYSTONE DR
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-7988
Country	:	US
Telephone Number	:	859-353-8884
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2020
Last Update Date	:	12/10/2025

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