Individual
TEQIENNA DIANNE RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
609 W MAPLE AVE, SPRINGDALE, AR 72764-5335
(479) 751-5711
Mailing address
200 CORPORATE BLVD, LAFAYETTE, LA 70508-3870
(800) 893-9698
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
A005617
AR
Other
Enumeration date
09/24/2018
Last updated
09/24/2018
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