Provider Demographics
NPI:1932449055
Name:RANDLE, KELLEE LORRAINE (DO)
Entity type:Individual
Prefix:DR
First Name:KELLEE
Middle Name:LORRAINE
Last Name:RANDLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-2231
Mailing Address - Country:US
Mailing Address - Phone:972-923-7144
Mailing Address - Fax:972-923-7145
Practice Address - Street 1:1405 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-2231
Practice Address - Country:US
Practice Address - Phone:972-923-7144
Practice Address - Fax:972-923-7145
Is Sole Proprietor?:No
Enumeration Date:2013-02-26
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS18511207R00000X, 208M00000X
MO2023047549207R00000X, 208M00000X
NC318494207R00000X, 208M00000X
TXP3570208M00000X, 207R00000X
OH34.016107207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01241139OtherMEDICARE RR
TXP01241139OtherMEDICARE RR