Randall Clifford Nedegaard, PH.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1126 Issued in KS

Practice address

1599 J St
319 Mdos/Sgoh
Grand Forks Afb, ND 58205-6306

Phone

(701) 747-7155

Fax

(701) 747-7340

NPI assigned

Oct 31, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1013908946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1520 MARCH DR",
            "city": "GRAND FORKS AFB",
            "state": "ND",
            "postal_code": "582041231",
            "telephone_number": "701-594-9508",
            "fax_number": "701-747-7340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1599 J ST",
            "address_2": "319 MDOS/SGOH",
            "city": "GRAND FORKS AFB",
            "state": "ND",
            "postal_code": "582056306",
            "telephone_number": "701-747-7155",
            "fax_number": "701-747-7340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEDEGAARD",
        "first_name": "RANDALL",
        "middle_name": "CLIFFORD",
        "name_prefix": "Dr.",
        "credential": "PH.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-31",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "KS",
            "license": "1126",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "123-1858",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Timothy Kresien
• James T Kwasneski, LCSW
• Benjamin Lofgren, DPT
• Rebecca Leigh McLean, D.O.
• Anthony Miller, LCSW
• Janet Nelson, LICSW
• William Niermeyer, DDS
• Mazin Nour Ahmed, DDS
• Bryan Keith Payne, M.D.
• Heather A Ray, PHARM. D.

• Clinical Psychologist in Grand Forks Afb, ND
• Providers in Grand Forks Afb, ND by specialty
• Clinical Psychologist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.