MEDICARE: RANDALL SCOTT HOMER NP, PA

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	363LA2200X	Adult Health Nurse Practitioner	17075	CA
2	363A00000X	Physician Assistant	19058	CA
3	363A00000X	Physician Assistant	10003505A	IN

General Provider Information

NPI Number	:	1356486021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDALL SCOTT HOMER NP, PA

Provider Business Mailing Address
First Line	:	9770 WOODHOLLOW WAY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95827-2724
Country	:	US
Telephone Number	:	916-362-5952
Fax Number	:

Provider Business Practice Location Address
First Line	:	3941 J ST
Second Line	:	SUITE 354
City	:	SACRAMENTO
State	:	CA
Zip	:	95819-3624
Country	:	US
Telephone Number	:	916-733-6870
Fax Number	:

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

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	05/26/2026

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