Organization
KIDS AVENUE PEDIATRICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. APRIL DAWN RANDLE FNP (ADMINISTRATOR)
(601) 941-0699
Entity
Organization
Contact information
Practice address
1061 LAKE VILLAGE CIR STE D1, BRANDON, MS 39047-6723
(601) 941-0699
Mailing address
1061 LAKE VILLAGE CIR STE D1, BRANDON, MS 39047-6723
(601) 941-0699
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
09/24/2021
Last updated
09/24/2021
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