Provider Demographics
NPI:1316128481
Name:RANDLE, CHERRY CECILIA
Entity type:Individual
Prefix:MS
First Name:CHERRY
Middle Name:CECILIA
Last Name:RANDLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3112 LOVING AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76106-5550
Mailing Address - Country:US
Mailing Address - Phone:817-319-5148
Mailing Address - Fax:
Practice Address - Street 1:3112 LOVING AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76106-5550
Practice Address - Country:US
Practice Address - Phone:817-319-5148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-17
Last Update Date:2007-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other