Doctor Name: | TIFFANY RANDALL |
NPI Number: | 1033521554 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APRN |
License Number: | 53-76367-082 |
Business Practice Address: | 7301 Mission Rd Ste 350 Prairie Village, KS - 662083075 |
Business Phone Number: | 9139456544 |
Business Fax Number: | 9139456540 |
Mailing Address: | 7301 Mission Rd Ste 350, PRAIRIE VILLAGE |
State: | KS |
Postal Code: | 662083075 |
Phone Number: | 9139456544 |
Fax Number: | 9139456540 |
NPI Enumeration Date: | 06/02/2014 |
NPI Last Update Date: | 06/02/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 53-76367-082 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KS |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |