Provider Demographics
NPI:1689664104
Name:RANDALL, ZELMA KATHERINE (FNP)
Entity type:Individual
Prefix:
First Name:ZELMA
Middle Name:KATHERINE
Last Name:RANDALL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ZELMA
Other - Middle Name:KATHERINE
Other - Last Name:DICHARRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:P. O. BOX 395
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70722-3210
Mailing Address - Country:US
Mailing Address - Phone:225-968-5292
Mailing Address - Fax:225-683-3411
Practice Address - Street 1:11990 JACKSON ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:LA
Practice Address - Zip Code:70722-3210
Practice Address - Country:US
Practice Address - Phone:225-968-5292
Practice Address - Fax:225-683-3411
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA325141986363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1995827Medicaid
LA5T494CQ60Medicare PIN
LA5T494Medicare ID - Type Unspecified
LA5T494CH71Medicare PIN
LA1995827Medicaid