Provider Demographics
NPI:1427687136
Name:DAILY, RANDA M (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:RANDA
Middle Name:M
Last Name:DAILY
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 S BOSLEY RD
Mailing Address - Street 2:
Mailing Address - City:SANTO
Mailing Address - State:TX
Mailing Address - Zip Code:76472-3652
Mailing Address - Country:US
Mailing Address - Phone:940-727-8101
Mailing Address - Fax:
Practice Address - Street 1:612 E LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-4121
Practice Address - Country:US
Practice Address - Phone:940-727-8101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-04
Last Update Date:2020-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX671201163W00000X
TXAP143673363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse