Individual provider Active NPI

Randa Khalid Salem, FNP-BC

  • Family Nurse Practitioner
  • Knoxville, TN
National Provider Identifier
1245073196
Registry record updated Apr 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
36158 Issued in TN
Practice address
501 19TH St Ste 401
Knoxville, TN 37916-1831
Phone
(865) 331-2020
NPI assigned
Jun 18, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 36158 TN
Family Nurse Practitioner 363LF0000X 36158 TN Primary

Addresses

Primary practice location

501 19TH St Ste 401
Knoxville, TN 37916-1831

Mailing address

501 19TH St Ste 401
Knoxville, TN 37916-1831
Phone (865) 331-2020

Other identifiers 1

IdentifierTypeStateIssuer
Q100970MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241107000255 TN Practitioner - Nurse Practitioner 6204360761 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
36158TNMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fort Sanders Perinatal Center CurrentSince Mar 17, 2025 Accepting new patients

Locations

501 19th St
Ste 401
Knoxville, TN 37916
Phone (865) 331-2020

Dept 888247
Knoxville, TN 37995

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1718668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744156800000",
    "number": "1245073196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 19TH ST STE 401",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379161831",
            "telephone_number": "865-331-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 19TH ST STE 401",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379161831",
            "telephone_number": "865-331-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SALEM",
        "first_name": "RANDA",
        "middle_name": "KHALID",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-18",
        "last_updated": "2025-04-09",
        "certification_date": "2025-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TN",
            "license": "36158",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "36158",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q100970",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Knoxville, TN

Sources for this page

Verify at the official NPI Registry.