DR. MARY KAY RANDOLPH MD NPI 1841203023

NPI Information

  • NPI: 1841203023
  • Provider Name: DR. MARY KAY RANDOLPH, MD
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 36584 W 220TH ST
    POLO, MO
    ZIP 64671
  • Phone: (816) 809-7730

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NPI Details

DR. Mary Kay Randolph, MD is a family medicine in Polo, MO with 34 years of experience. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. DR. Mary Kay Randolph, MD NPI is 1841203023. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

Education
Medical School: UNIVERSITY OF KANSAS SCHOOL OF MED (KC/WICH/SAL)
Graduation Year:1992

The provider's business location address is:

36584 W 220TH ST
POLO, MO
ZIP 64671-669
Phone: (816) 809-7730

The NPI 1841203023 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 8/15/2006 and was last updated on 9/19/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily Medicine036-121726ILLINOISNo
2207Q00000XFamily Medicine04-25049KANSASNo
3207Q00000XFamily Medicine101542MISSOURIYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1068002402OTHERKANSASMEDICARE PTAN
2100175570CMEDICAIDKANSAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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