Individual provider Active NPI

Jacquia Aprale Randson, PNP

  • Nurse Practitioner
  • Concord, NC
National Provider Identifier
1699535153
Registry record updated Apr 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5019809 Issued in NC
Practice address
9955 Poplar Tent Rd
Concord, NC 28027-9314
Phone
(704) 316-2354
Fax
(704) 316-2357
NPI assigned
Mar 21, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 5019809 NC Primary

Addresses

Primary practice location

9955 Poplar Tent Rd
Concord, NC 28027-9314

Mailing address

PO Box 60447
Charlotte, NC 28260-0447

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20240506003170 NC Practitioner - Nurse Practitioner 3577903681 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5019809NCMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group LLC CurrentSince May 3, 2024 Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
Novant Health Medical Group, LLC CurrentSince May 3, 2024 Accepting new patients
Novant Health Medical Group, LLC Past Accepting new patients

Locations

6331 Carmel Rd
Ste 102
Charlotte, NC 28226
Phone (704) 316-2354

517 S Sharon Amity Rd
Charlotte, NC 28211
Phone (704) 384-1406

9955 Poplar Tent Rd
Concord, NC 28027
Phone (704) 316-1161

311 Coddle Market Dr NW
Ste 100
Concord, NC 28027
Phone (980) 302-9100

5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

Interoperability endpoints

  • Direct secure messaging: jrandson1461975@direct.novanthealth.org

Organizations & group practices 4

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": "1710979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714435200000",
    "number": "1699535153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9955 POPLAR TENT RD",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280279314",
            "telephone_number": "704-316-2354",
            "fax_number": "704-316-2357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDSON",
        "first_name": "JACQUIA",
        "middle_name": "APRALE",
        "name_prefix": "Ms.",
        "credential": "PNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-21",
        "last_updated": "2024-04-30",
        "certification_date": "2024-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5019809",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Concord, NC

Sources for this page

Verify at the official NPI Registry.