Individual
SYDNEY LANELL RANDALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGACNP
Contact information
Practice address
3551 ROGER BROOKE DR, FORT SAM HOUSTON, TX 78234-4504
(301) 925-2900
(706) 868-8375
Mailing address
PO BOX 12187, AUGUSTA, GA 30914-2187
(706) 863-9595
(706) 868-8375
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1019049
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR2705878
—
TX
Enumeration date
01/21/2021
Last updated
01/21/2024
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