Mary Randolph, RN

Primary specialty

Administrator Registered NurseTaxonomy code 163WA2000X

License

115016 Issued in CO

Practice address

497 West 4TH Street
Dove Creek, CO 81324-0368

Phone

(970) 677-2387

Fax

(970) 677-2948

NPI assigned

May 23, 2012

Sex

Female

Sole proprietor

No

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.

• Dolores County Commissioners

  • Public Health or Welfare Agency
  • Dove Creek, CO
  • NPI 1174772073
  NPD (past) Authorized official

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 23, 2012.

{
    "created_epoch": "1337731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1337731200000",
    "number": "1396005443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 368",
            "city": "DOVE CREEK",
            "state": "CO",
            "postal_code": "813240368",
            "telephone_number": "970-677-2387",
            "fax_number": "970-677-2948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "497 WEST 4TH STREET",
            "city": "DOVE CREEK",
            "state": "CO",
            "postal_code": "813240368",
            "telephone_number": "970-677-2387",
            "fax_number": "970-677-2948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDOLPH",
        "first_name": "MARY",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-23",
        "last_updated": "2012-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WA2000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Administrator",
            "state": "CO",
            "license": "115016",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stacey Gray, CPHT
• Jordan Val Kofoed, DDS
• Janet Lowe
• Thomas Loyd Myers, RN
• Tiffany Parisi, CPT
• Mark A. Schwartz, PA-C
• Southwest Colorado Mental Health Center Inc
• Southwest Colorado Mental Health Center, Inc
• Southwest Colorado Mental Health Center, Inc
• Southwest Colorado Mental Health Center, Inc

• All providers in Dove Creek, CO
• Administrator Registered Nurse in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2012; 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.