Randle, Jan Sullivan

Randle, Jan Sullivan is an individual health care provider with primary practice located at 14724 Highway 15 N , Louisville MS 39339-6318. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as her primary health care specialty. Randle, Jan Sullivan can be contacted via phone (662) 773-7500.

Contact Information

Primary practice address
14724 Highway 15 N Louisville MS 39339-6318
Phone: (662) 773-7500
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X R652962 Mississippi

Profile Details

NPI number 1184675134
LBN Legal business name Randle, Jan Sullivan
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 No
Enumeration date May 15th, 2006
Last updated Mar 10th, 2020 - about 5 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 1184675134 NPPES
Mississippi MEDICAID 00118926

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