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Individual

MR. CODY RANDY CHARLTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
801 W MAPLE ST, FARMINGTON, NM 87401-5630
(505) 609-2258
(505) 609-2259
Mailing address
PO BOX 3570, SALT LAKE CITY, UT 84110-3570
(801) 727-2056
(770) 701-6675

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
5130028-4406
UT
367500000X
Certified Registered Nurse Anesthetist
Primary
AP127707
TX
367500000X
Certified Registered Nurse Anesthetist
CRNA-01505
NM

Other

Enumeration date
09/11/2006
Last updated
03/03/2025
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