MRS. TAHLIA MAE RANDALL (NPI# 1790204055) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790204055 |
| Entity Type | Individual |
| Full Name | MRS. TAHLIA MAE RANDALL |
| Credential | PHYSICIAN ASSISTANT |
| Practice Address |
217 Glensford Dr Fayetteville NC 28314 |
| Mailing Address |
217 Glensford Dr Fayetteville NC 28314-0892 |
| Practice Telephone | 9104834647 |
| Enumeration Date | 2017-09-18 |
| Last Update Date | 2019-11-14 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 10-09313 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1995 E Oakland Park Blvd Ste 250, Fort Lauderdale, FL 333061149 | 9547916146 |
| Street Address |
217 GLENSFORD DR |
| City | FAYETTEVILLE |
| State | NC |
| Zip Code | 28314 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669473153 | Kerry Clancy | Physician Assistant | 217 Glensford Dr, Fayetteville, NC 28314 | 2005-08-09 |
| 1396390563 | Jane Lingao Punzalan | Nurse Practitioner | 217 Glensford Dr, Fayetteville, NC 28314-0892 | 2019-08-05 |
| 1588221394 | Lindsey Catherine Oberacker | Physician Assistant | 217 Glensford Dr, Fayetteville, NC 28314-0892 | 2019-05-28 |
| 1578070843 | Herman Albert Allison | Nurse Practitioner | 217 Glensford Dr, Fayetteville, NC 28314-0892 | 2018-01-08 |
| 1003093758 | Phytcare LLC | Physical Medicine & Rehabilitation | 217 Glensford Dr, Fayetteville, NC 28314-0892 | 2008-01-24 |
| 1629166616 | Susan Kinsella | Emergency Medicine | 217 Glensford Dr, Fayetteville, NC 28314-0892 | 2006-10-11 |
| 1891898052 | Michael A Heter | Family Medicine | 217 Glensford Dr, Fayetteville, NC 28314 | 2006-09-06 |
| 1144254376 | Matrix Occupational Health Inc | Clinic/Center | 217 Glensford Dr, Suite B, Fayetteville, NC 28314-0892 | 2006-07-11 |
| 1962459404 | Marshall Edward Putnam | Physician Assistant | 217 Glensford Dr, Fayetteville, NC 28314-0892 | 2006-05-30 |
| 1144279670 | Matrix Occupational Health Inc | Clinic/Center | 217 Glensford Dr, Suite A, Fayetteville, NC 28314-0892 | 2006-05-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528677812 | Lamonica Laveta Greene | Massage Therapist | 7804 Loxley Drive, Fayetteville, NC 28314 | 2020-07-23 |
| 1467086496 | The Pair Center for Couples Counseling Pllc | Counselor | 5085 Morganton Road, Suite 300, Fayetteville, NC 28314 | 2020-02-28 |
| 1346898335 | Chaitanya Joopally Dds Pllc | Dentist | 2050 Skibo Rd. Ste 104, Fayetteville, NC 28314 | 2019-09-03 |
| 1780231894 | Bio-medical Applications of North Carolina, Inc. | Clinic/Center | 2360 Williamwood Lane, Fayetteville, NC 28314 | 2019-08-22 |
| 1164075982 | A Touch of Grace Inc | Day Training/Habilitation Specialist | 2153 Heathcote Drive, Fayetteville, NC 28314 | 2019-07-21 |
| 1093284465 | Candice Gorremans | Physician Assistant | 108th Air Defense Artillery Brigade, Fort Bragg, NC 28314 | 2018-11-15 |
| 1861983439 | Jessica Lynne Smith | Counselor | 6885 Cliffdale Rd Ste 2002, Fayetteville, NC 28314 | 2018-05-19 |
| 1073003752 | Gooden Mobile Pod Nc Pllc | Podiatrist | 311 Mcfadyen Dr, Fayetteville, NC 28314 | 2018-05-17 |
| 1093222101 | Lauren Bonneau | Behavioral Analyst | 6985 Nexus Ct, Suite 107, Fayetteville, NC 28314 | 2018-01-10 |
| 1760900153 | Elali Alisha Marie Moukwa | Dentist | 1916 Skibo Rd Ste C3, Fayetteville, NC 28314 | 2017-09-06 |
| Find all providers in zip 28314 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306443387 | Melissa Macneil Spencer | Physician Assistant | 810 Knighthood Cir, Fayetteville, NY 13066-8721 | 2020-10-03 |
| 1366067548 | Prathna Raval | Physician Assistant | 6808 Thames Dr, Fayetteville, NC 28306-2524 | 2020-06-12 |
| 1205465895 | Gillian Vaughan Heard | Physician Assistant | 1275 Ga-54 #201, Fayetteville, GA 30214 | 2020-04-06 |
| 1144858515 | Mackenzie Anna Kirchner | Physician Assistant | 568 Sandy Creek Rd, Fayetteville, GA 30214-4205 | 2020-03-31 |
| 1770116931 | Chasity Nicole Sullivan | Physician Assistant | 202b Highland Ave, Fayetteville, NC 28305-5308 | 2020-02-17 |
| 1740812833 | Madeline Everitt Monday | Physician Assistant | 705 Stonington Dr, Fayetteville, NC 28311-0329 | 2020-02-07 |
| 1396375325 | Lisa Ann Gross | Physician Assistant | 3007 Town Center Dr Ste 100, Fayetteville, NC 28306-3663 | 2020-01-17 |
| 1811536048 | Kelly Hamilton Sweatt | Physician Assistant | 1991 Fordham Dr Ste 200, Fayetteville, NC 28304-3774 | 2020-01-06 |
| 1922563667 | Reandy Nicole Hearn | Physician Assistant | 2911 Breezewood Ave Ste 100, Fayetteville, NC 28303-5464 | 2019-02-06 |
| 1790259430 | Cassandra Ann Nebosky-diaz | Physician Assistant | 659 Daharan Dr, Fayetteville, NC 28314-6538 | 2019-01-16 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 28314 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.