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NPI Code Detail

MEDICARE: RANDI NICOLE BOUCHILLON DNP, FNP-C

MEDICARE: RANDI NICOLE BOUCHILLON DNP, 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
1163WP0200XPediatric Registered NurseR244896MD
2363LF0000XFamily Nurse PractitionerR244896MD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2R244896OTHERMDRN

General Provider Information

NPI Number : 1437888138
Entity Type Code : Individual
Provider Name (Legal Business Name) : RANDI NICOLE BOUCHILLON DNP, FNP-C
Provider Business Mailing Address
First Line : 85 HOSPITAL RD
Second Line :
City : PRINCE FREDERICK
State : MD
Zip : 20678-4018
Country : US
Telephone Number : 240-717-9661
Fax Number : 410-535-1505
Provider Business Practice Location Address
First Line : 85 HOSPITAL RD
Second Line :
City : PRINCE FREDERICK
State : MD
Zip : 20678-4018
Country : US
Telephone Number : 410-535-2300
Fax Number : 410-535-1505
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2022
Last Update Date : 05/26/2026

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