Individual
JESSICA CHARIS RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
500 E THORPE ST, LAKIN, KS 67860-9625
(620) 355-7111
Mailing address
805 S BOUZIDEN DR, MOORE, OK 73160-7324
(620) 952-1546
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
206118
OK
363LF0000X
Family Nurse Practitioner
Primary
53-83783-011
KS
Other
Enumeration date
11/19/2024
Last updated
12/02/2024
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