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NPI Code Detail

MEDICARE: MS. RANDI TERRY DAVIS CRNA

MEDICARE: MS. RANDI TERRY DAVIS CRNA
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
1367500000XCertified Registered Nurse Anesthetist4704197826MI
2367500000XCertified Registered Nurse Anesthetist306445NY
3367500000XCertified Registered Nurse Anesthetist26NJ00306400NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14308759910OTHERMIBCBS INDIVIDUAL PIN
24308712580OTHERMIBCBS - MICHIGAN
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1295815892
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. RANDI TERRY DAVIS CRNA
Provider Business Mailing Address
First Line : 339 CONSORT DR
Second Line :
City : BALLWIN
State : MO
Zip : 63011-4439
Country : US
Telephone Number : 636-386-9224
Fax Number : 636-386-7679
Provider Business Practice Location Address
First Line : 736 IRVING AVE
Second Line :
City : SYRACUSE
State : NY
Zip : 13210-1602
Country : US
Telephone Number : 315-470-7111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2006
Last Update Date : 02/24/2026

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