Jamie L. Randall, FNP, PMHNP

Key facts

NPI: 1790043792
Entity type: Individual (NPI type 1)
Primary specialty: Psychiatric/Mental Health Nurse Practitioner 363LP0808X
License: 2017001301 (MO)
Practice address: 411 3Rd St
Monett, MO 65708-2008
Phone: (417) 235-6610
Fax: (417) 354-0065
NPI assigned: Apr 26, 2012
Sex: Female
Sole proprietor: No

Organizations & group practices 2

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.

Clark Community Mental Health Center Community/Behavioral Health Agency · Monett, MO · NPI 1801807771

Medicare reassignment Care Compare group NPD MO
Clark Community Mentalhealth Center Children's Substance Abuse Rehabilitation Facility · Monett, MO · NPI 1912337692

NPD (past)

Medicare Care Compare profile

Specialty: Nurse Practitioner
Education: Other, 2011
Medicare assignment: Accepts the Medicare-approved amount as payment in full
Telehealth: Offers telehealth services
Group practices: Clark Community Mental Health Center (25 clinicians)

Practice addresses (Care Compare)

1701 N Central Ave
Monett, MO 65708-1144
Phone (417) 235-6610

Medicare participation

Medicare fee-for-service enrollment: Enrolled in MO
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20120727000720	MO	Practitioner - Nurse Practitioner	5496911190	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes

State licenses

License	State	Type	Specialty
2012011476	MO	MD	Family Nurse Practitioner
2017001301	MO	MD	Psychiatric/Mental Health Nurse Practitioner

Practice roles

Organization	Specialty	Status	New patients
Clark Community Mental Health Center		Current since Jan 20, 2015	Accepting new patients
Clark Community Mentalhealth Center		Past	Accepting new patients

Locations

411 3rd St
Monett, MO 65708
Phone (417) 235-6610

1701 N Central Ave
Monett, MO 65708
Phone (417) 235-6610

104 W Main St
Pierce City, MO 65723
Phone (417) 235-6610

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Family Nurse Practitioner	363LF0000X	2012011476	MO
Psychiatric/Mental Health Nurse Practitioner	363LP0808X	2017001301	MO	Yes

Addresses

Primary practice location

411 3Rd St
Monett, MO 65708-2008

Mailing address

PO Box 100
Pierce City, MO 65723-2100
Phone (417) 476-1000

Other practice location 1

315 E Cleveland Ave
Monett, MO 65708-1704
Phone (417) 235-4334

Other providers in Monett, MO

All providers in Monett, MO · Psychiatric/Mental Health Nurse Practitioner in Missouri

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 19, 2018. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.