Individual
KATIE RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
115 PR 1295, FAIRFIELD, TX 75840
(903) 907-1637
Mailing address
115 PR 1295, FAIRFIELD, TX 75840
(903) 907-1637
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
208619
TX
Other
Enumeration date
06/23/2020
Last updated
06/23/2020
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