MEDICARE: DR. JEANNINE MARIE FERRIGNO RANDOLPH DMS, CHA, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RA0000X	Adolescent Medicine (Internal Medicine) Physician	1527	CO
2	363A00000X	Physician Assistant	PA.0001527	CO

General Provider Information

NPI Number	:	1144469354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEANNINE MARIE FERRIGNO RANDOLPH DMS, CHA, PA

Provider Business Mailing Address
First Line	:	PO BOX 35380
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-5380
Country	:	US
Telephone Number	:	702-579-3203
Fax Number	:

Provider Business Practice Location Address
First Line	:	32135 CASTLE CT STE 101
Second Line	:
City	:	EVERGREEN
State	:	CO
Zip	:	80439-8006
Country	:	US
Telephone Number	:	303-679-8500
Fax Number	:	303-972-0026

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2009
Last Update Date	:	04/15/2026

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