Healthcare Provider Details

I. General information

NPI: 1972130607
Provider Name (Legal Business Name): KATHERINE LETHA RANDOLPH DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 GILLHAM RD
KANSAS CITY MO
64108-4619
US

IV. Provider business mailing address

2401 GILLHAM RD PROVIDER ENROLLMENT DEPARTMENT
KANSAS CITY MO
64108-4619
US

V. Phone/Fax

Practice location:
  • Phone: 168-234-3000
  • Fax: 816-302-9939
Mailing address:
  • Phone: 168-234-3000
  • Fax: 816-302-9939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number2023025032
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2023025032
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: