Provider Demographics
NPI:1063913465
Name:GUY, RANDY (FNP)
Entity type:Individual
Prefix:MR
First Name:RANDY
Middle Name:
Last Name:GUY
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 OLD HICKORY BLVD STE L
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2500
Mailing Address - Country:US
Mailing Address - Phone:731-661-2750
Mailing Address - Fax:
Practice Address - Street 1:180 OLD HICKORY BLVD STE L
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2500
Practice Address - Country:US
Practice Address - Phone:731-661-2750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23913363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily