| Doctor Name: | RENDALL NORTHCUTT |
| NPI Number: | 1013325638 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | APN |
| License Number: | AP126102 |
| Business Practice Address: | 11937 Us Highway 271 Tyler, TX - 757083154 |
| Business Phone Number: | 9038777200 |
| Business Fax Number: | 9038775080 |
| Mailing Address: | Po Box 731912, DALLAS |
| State: | TX |
| Postal Code: | 753731912 |
| Phone Number: | 9038777200 |
| Fax Number: | 9038775080 |
| NPI Enumeration Date: | 07/28/2014 |
| NPI Last Update Date: | 10/19/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP2300X |
| License Number: | AP126102 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |