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NPI Code Detail

MEDICARE: BEVERLY JAN RANDLE F.N.P.

MEDICARE: BEVERLY JAN RANDLE F.N.P.
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
1363L00000XNurse PractitionerR652962MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184675134
Entity Type Code : Individual
Provider Name (Legal Business Name) : BEVERLY JAN RANDLE F.N.P.
Provider Business Mailing Address
First Line : 8613 MS HIGHWAY 12
Second Line :
City : ACKERMAN
State : MS
Zip : 39735-8917
Country : US
Telephone Number : 662-285-9460
Fax Number :
Provider Business Practice Location Address
First Line : 14724 HIGHWAY 15 N
Second Line :
City : LOUISVILLE
State : MS
Zip : 39339-6318
Country : US
Telephone Number : 662-773-7500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2006
Last Update Date : 07/07/2025

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