Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Tyler William Randall

Individual provider Nurse Practitioner · NPI 1780241794

Tyler William Randall is a Nurse Practitioner in Canon City, Colorado. Qualified in 2019, 7 years ago. Practices with Fhpg LLC, a 197-clinician group and accepts Medicare assignment. Licensed in Colorado and Washington.

Years since qualifying
7
Licensed in
CO, WA
In the registry since
2019
Specialties on file
3

Practice location Address checks out

1338 Phay Ave
Canon City, CO 81212-2311
Phone: (719) 285-2000
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence APN.0994692-NP (CO)
Nurse Practitioner Taxonomy 363L00000X · Licence AP61177225 (WA)
Family Nurse Practitioner Taxonomy 363LF0000X · Licence AP61177225 (WA)

Record details

NPI number1780241794
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedMay 24, 2019
Last updated in NPPESJune 19, 2024
Certification dateJune 19, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Fhpg Llc — 197 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Canon City