Young, Randall Wayne

Young, Randall Wayne is an individual health care provider with primary practice located at 906 Judson Rd , Longview TX 75601-5113. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as his primary health care specialty. Young, Randall Wayne can be contacted via phone (903) 331-0506.

Contact Information

Primary practice address
906 Judson Rd Longview TX 75601-5113
Phone: (903) 331-0506
Fax: (903) 331-0462
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 72566 Texas
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 660218 Texas

Profile Details

NPI number 1124064258
LBN Legal business name Young, Randall Wayne
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 20th, 2006
Last updated Aug 14th, 2009 - about 15 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 1124064258 NPPES
Texas MEDICAID 171-84-7001
Texas MEDICAID 171847001

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