Randall, Judith Myrick

Randall, Judith Myrick is an individual health care provider with primary practice located at 1890 Waite St Ste 1, North Bend OR 97459-1229. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Family, Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Randall, Judith Myrick can be contacted via phone (541) 756-6232.

Contact Information

Primary practice address
1890 Waite St Ste 1 North Bend OR 97459-1229
Phone: (541) 756-6232
Fax: (541) 756-6234
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X AP30007876 Washington
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 201250024 Oregon
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X 201250025NP Oregon

Profile Details

NPI number 1891978763
LBN Legal business name Randall, Judith Myrick
Credentials ARNP
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 13th, 2007
Last updated Jun 22nd, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1891978763 NPPES
Other 1619915113 WATERFALL CLINIC, INC. GROUP NPI
MEDICAID 213342 WATERFALL CLINIC, INC. GROUP NPI
Other R120353 WATERFALL CLINIC, INC. GROUP NPI

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