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Individual

SALLIE ELIZABETH RANDALL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
800 ROSE ST, LEXINGTON, KY 40536-5837
(859) 323-6047
(859) 257-3873
Mailing address
800 ROSE ST, LEXINGTON, KY 40536-7001
(859) 323-6047

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2895
KY
363A00000X
Physician Assistant
TC088
KY
363AM0700X
Medical Physician Assistant
PA2895
KY
363AM0700X
Medical Physician Assistant
TC088
KY
363AS0400X
Surgical Physician Assistant
PA2895
KY
363AS0400X
Surgical Physician Assistant
TC088
KY

Other

Enumeration date
10/31/2019
Last updated
01/27/2022
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