Individual provider Active NPI

Ada Pauline Randall

  • Licensed Vocational Nurse
  • Anchorage, AK
National Provider Identifier
1306131446
Registry record updated Feb 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Vocational NurseTaxonomy code 164X00000X
License
142293 Issued in AK
Practice address
670 W Fireweed LN Ste 160
Anchorage, AK 99503-2561
Phone
(907) 770-0862
NPI assigned
Jun 16, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Vocational Nurse 164X00000X 253763 CA
Licensed Vocational Nurse 164X00000X 142293 AK Primary

Addresses

Primary practice location

670 W Fireweed LN Ste 160
Anchorage, AK 99503-2561

Mailing address

648 Whitetail Dr
Fleetwood, NC 28626-9280
Phone (706) 331-3508

Other practice location 1

427 C St
Suite 212
San Diego, CA 92101-5100
Phone (619) 238-4180

Other practice location 2

648 Whitetail Dr
Fleetwood, NC 28626-9280
Phone (706) 331-3508

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
142293AKMDLicensed Vocational Nurse
253763CAMDLicensed Vocational Nurse

NPI Registry JSON

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

{
    "created_epoch": "1308182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550707200000",
    "number": "1306131446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "648 WHITETAIL DR",
            "city": "FLEETWOOD",
            "state": "NC",
            "postal_code": "286269280",
            "telephone_number": "706-331-3508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "670 W FIREWEED LN STE 160",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995032561",
            "telephone_number": "907-770-0862"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "427 C St",
            "address_2": "Suite 212",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921015100",
            "country_code": "US",
            "telephone_number": "619-238-4180",
            "fax_number": "618-238-4245",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "648 Whitetail Dr",
            "address_purpose": "LOCATION",
            "city": "Fleetwood",
            "state": "NC",
            "postal_code": "286269280",
            "country_code": "US",
            "telephone_number": "706-331-3508",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RANDALL",
        "first_name": "ADA",
        "middle_name": "PAULINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-16",
        "last_updated": "2019-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "253763",
            "primary": false
        },
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "AK",
            "license": "142293",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Anchorage, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2019; 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.