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General NPI Number Information
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NPI Number | 1730447525
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Entity Type | Individual
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Provider Name | JESS T. RANDALL MD
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Gender | Male
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Dates
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Enumeration Date | 04/30/2012
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 740 S LIMESTONE STE L203
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City | LEXINGTON
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State | KY
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Zip | 40536-0001
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Country | US
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Telephone | 859-323-6754
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Fax | 859-323-3499
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Provider Business Mailing Address
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Address Line | 319 S. MANNING BLVD SUITE 203
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City | ALBANY
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State | NY
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Zip | 12208
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Country | US
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Telephone | 518-489-3292
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Fax | 518-453-6786
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | 306608
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 35.151910
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | 59406
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License Number State | KY
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