Provider Demographics
NPI:1386328128
Name:RANDLE, DAVID EVERETT (APRN)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:EVERETT
Last Name:RANDLE
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 WRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TN
Mailing Address - Zip Code:37874-2130
Mailing Address - Country:US
Mailing Address - Phone:865-643-0743
Mailing Address - Fax:
Practice Address - Street 1:1103 WRIGHT ST
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TN
Practice Address - Zip Code:37874-2130
Practice Address - Country:US
Practice Address - Phone:865-643-0743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34087363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care