Individual
KIM RANDOLPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
703 60TH STREET CT E, SUITE K, BRADENTON, FL 34208-6278
(941) 748-6024
(941) 748-6039
Mailing address
703 60TH STREET CT E, SUITE K, BRADENTON, FL 34208-6278
(941) 748-6024
(941) 748-6039
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN921328
FL
163WC0400X
Case Management Registered Nurse
RN921328
FL
163WD0400X
Diabetes Educator Registered Nurse
RN921328
FL
163WH0200X
Home Health Registered Nurse
RN921328
FL
163WH0500X
Hemodialysis Registered Nurse
RN921328
FL
163WI0500X
Infusion Therapy Registered Nurse
RN921328
FL
Other
Enumeration date
09/22/2014
Last updated
09/22/2014
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