MEDICARE: ALEXIS RANDALL

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1295678811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS RANDALL

Provider Business Mailing Address
First Line	:	13512 SANDERLING PL
Second Line	:
City	:	GERMANTOWN
State	:	MD
Zip	:	20874-3468
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	29 BEE ST
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29425-0001
Country	:	US
Telephone Number	:	843-876-7645
Fax Number	:

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

Provider Enumeration Date	:	04/09/2026
Last Update Date	:	04/09/2026

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Directions to “ ALEXIS RANDALL ” Practice Location

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