Provider Demographics
NPI:1235818295
Name:RANDOLPH, AMY MICHELLE (DNP, FNP-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MICHELLE
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 RANDOLPH DR
Mailing Address - Street 2:
Mailing Address - City:RICE
Mailing Address - State:VA
Mailing Address - Zip Code:23966-2317
Mailing Address - Country:US
Mailing Address - Phone:434-547-0366
Mailing Address - Fax:
Practice Address - Street 1:833 BUFFALO ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-1111
Practice Address - Country:US
Practice Address - Phone:434-392-8177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001269946163W00000X
VA0024191482363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse