Basic Information
| Provider Information | |||||||||
| NPI: | 1124178660 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RADNEDGE | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | RANDALL | ||||||||
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| Credential: | RNC,NNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9571 COUNTY ROAD 2440 | ||||||||
| Address2: | |||||||||
| City: | ROYSE CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751893083 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1301 PENNSYLVANIA AVE | ||||||||
| Address2: | |||||||||
| City: | FT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761042122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172502892 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LN0000X | 641431 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Neonatal |
No ID Information.