Individual provider · Type 1 NPI
Jessica Randolph, LPC, PA
Medical Physician Assistant · Tahlequah, OK
NPI number
1174842215
Active
Practice location
100 S Bliss Ave
Tahlequah, OK 74464-2512
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Professional Counselor | 101YP2500X | 5388 (OK) |
| Medical Physician Assistant Primary | 363AM0700X | 3205 (OK) |
Medical Physician Assistant: Definition to come...
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About NPI 1174842215
Jessica Randolph, LPC, PA's National Provider Identifier is 1174842215, issued on May 28, 2010. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Tahlequah, OK. The record was last updated on May 5, 2026.