Individual
MRS. GLYNNIS D RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
F.N.P.
Contact information
Practice address
975 HALL ST, WIGGINS, MS 39577-2107
(601) 528-9119
(601) 528-9193
Mailing address
PO BOX 1007, LUCEDALE, MS 39452-1007
(601) 947-1332
(601) 947-1331
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R764278
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0116288
—
MS
Enumeration date
08/20/2006
Last updated
11/22/2016
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