MEDICARE: MRS. RANDIE R SALMON FNP

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	F332395-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	141347719	OTHER	NY	BCBS U/W
2	490811002	OTHER	NY	B/S
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770582256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RANDIE R SALMON FNP

Provider Business Mailing Address
First Line	:	427 GUY PARK AVE
Second Line	:	ST. MARY'S HEALTHCARE
City	:	AMSTERDAM
State	:	NY
Zip	:	12010-1054
Country	:	US
Telephone Number	:	518-841-7430
Fax Number	:	518-841-7121

Provider Business Practice Location Address
First Line	:	700 S PERRY ST
Second Line	:	JOHNSTOWN HEALTH CENTER
City	:	JOHNSTOWN
State	:	NY
Zip	:	12095-3213
Country	:	US
Telephone Number	:	518-762-3161
Fax Number	:	518-762-4902

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	04/26/2013

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