Active NPI
Diane R. Randolph, FNP-BC
- Family Nurse Practitioner
- Dallas, TX
National Provider Identifier
1376776344
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 243698
- Practice address
- 3600 Gaston Ave
Suite 651
Dallas, TX 75246-1800 - Phone
- (214) 820-8500
- Fax
- (214) 820-8168
- NPI assigned
- Aug 25, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 243698 | TX | Primary |
Addresses
Primary practice location
3600 Gaston Ave
Suite 651
Dallas, TX 75246-1800
Mailing address
3600 Gaston Ave
Suite 651
Dallas, TX 75246-1800
Phone (214) 820-8500
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 205998201 | Medicaid | TX | |
| 205998202 | Medicaid | TX |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 243698 | TX | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1251158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1275955200000",
"number": "1376776344",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3600 GASTON AVE",
"address_2": "SUITE 651",
"city": "DALLAS",
"state": "TX",
"postal_code": "752461800",
"telephone_number": "214-820-8500",
"fax_number": "214-820-8168"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3600 GASTON AVE",
"address_2": "SUITE 651",
"city": "DALLAS",
"state": "TX",
"postal_code": "752461800",
"telephone_number": "214-820-8500",
"fax_number": "214-820-8168"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDOLPH",
"first_name": "DIANE",
"middle_name": "R.",
"credential": "FNP-BC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-08-25",
"last_updated": "2010-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "TX",
"license": "243698",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "205998201",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "205998202",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.