Provider Demographics
NPI:1982109526
Name:RANDLE, MIA DAWN (FNP-C)
Entity type:Individual
Prefix:MS
First Name:MIA
Middle Name:DAWN
Last Name:RANDLE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 JIM ALLEN BLAKE RD
Mailing Address - Street 2:
Mailing Address - City:CEDARBLUFF
Mailing Address - State:MS
Mailing Address - Zip Code:39741-7048
Mailing Address - Country:US
Mailing Address - Phone:662-307-7099
Mailing Address - Fax:
Practice Address - Street 1:34 GLENWOOD DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-1596
Practice Address - Country:US
Practice Address - Phone:662-307-7099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2025-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS907911363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily