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NPI Code Detail

MEDICARE: RANDAL HERBERT FNP-C

MEDICARE: RANDAL HERBERT FNP-C
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
1363LF0000XFamily Nurse PractitionerF0613731LA

General Provider Information

NPI Number : 1356781819
Entity Type Code : Individual
Provider Name (Legal Business Name) : RANDAL HERBERT FNP-C
Provider Business Mailing Address
First Line : 4200 IOLA ST.
Second Line :
City : METAIRIE
State : LA
Zip : 70001
Country : US
Telephone Number : 504-296-0777
Fax Number : 504-455-2992
Provider Business Practice Location Address
First Line : 14116 CUSTOMS BLVD
Second Line :
City : GULFPORT
State : MS
Zip : 39503-5164
Country : US
Telephone Number : 601-957-6300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2013
Last Update Date : 10/25/2019

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