MEDICARE: SHERRI L RANDOLPH APRN, BC

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	363LF0000X	Family Nurse Practitioner	7531	TN

General Provider Information

NPI Number	:	1639175854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERRI L RANDOLPH APRN, BC

Provider Business Mailing Address
First Line	:	5683 S REX RD
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-3821
Country	:	US
Telephone Number	:	731-507-0272
Fax Number	:	615-384-9947

Provider Business Practice Location Address
First Line	:	1720 E REELFOOT AVE STE 200
Second Line	:
City	:	UNION CITY
State	:	TN
Zip	:	38261
Country	:	US
Telephone Number	:	731-507-0272
Fax Number	:	731-507-0273

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	09/17/2019

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