| Doctor Name: | LESLEY RANDOLL |
| NPI Number: | 1104240035 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CNS |
| License Number: | 2014003661 |
| Business Practice Address: | 1611 S Baltimore St Kirksville, MO - 635014536 |
| Business Phone Number: | 6606657575 |
| Business Fax Number: | 6606657576 |
| Mailing Address: | 1611 S Baltimore St, KIRKSVILLE |
| State: | MO |
| Postal Code: | 635014536 |
| Phone Number: | 6606657575 |
| Fax Number: | 6606657576 |
| NPI Enumeration Date: | 02/12/2014 |
| NPI Last Update Date: | 02/12/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 364SG0600X |
| License Number: | 2014003661 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Clinical Nurse Specialist |
| Taxonomy Specialization: | Gerontology |
| Taxonomy Definition: | |