Basic Information
| Provider Information | |||||||||
| NPI: | 1215210943 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BIBLE | ||||||||
| FirstName: | RANDALL | ||||||||
| MiddleName: | BLAKE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | II | ||||||||
| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1021 COOLIDGE ST | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | GREENEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377434672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236360702 | ||||||||
| FaxNumber: | 4236360709 | ||||||||
| Practice Location | |||||||||
| Address1: | 1021 COOLIDGE ST | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | GREENEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377434672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236360702 | ||||||||
| FaxNumber: | 4236360709 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2011 | ||||||||
| LastUpdateDate: | 10/18/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | APN16106 | TN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | APN16106 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.