Provider Demographics
NPI:1427489079
Name:RANDALL, KARA (FNP-C)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:RANDALL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15505 E 127TH ST
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-4433
Mailing Address - Country:US
Mailing Address - Phone:630-257-5400
Mailing Address - Fax:
Practice Address - Street 1:15505 E 127TH ST
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-4433
Practice Address - Country:US
Practice Address - Phone:630-257-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.410712163W00000X
IL209.011066363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse