MACKENZIE RANDOLPH
NPI 1073482014
Nurse Practitioner - Family in Dallas, TX

Q: What is the provider's specialty?

The provider's specialty is Nurse Practitioner with taxonomy code 363LF0000X and a focus in Family.

Active since October 29, 2025PECOS Enrolled

3133 E LEMMON AVE, DALLAS, TX 75204(214) 599-2108 Get Directions Write a Review

NPPES record last updated: June 3, 2026. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Jun 3, 2026, May 8, 2026, Apr 10, 2026 (3 updates tracked since 2026).

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About Mackenzie Randolph NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MACKENZIE RANDOLPH (NPI 1073482014) is an individual family provider in Dallas, Texas, licensed in Texas (1231411) and active in the NPI registry since October 2025. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1073482014

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameMACKENZIE RANDOLPH

Location Address3133 E LEMMON AVEDallas, TX 75204-1411

Mailing Address3133 E Lemmon AveDallas, TX 75204-1411 · (817) 599-2108

Phone(214) 599-2108

Sole ProprietorNo

Enumeration DateOctober 29, 2025

Last NPPES UpdateJune 3, 20263 updates tracked since enumeration

NPPES CertifiedJune 3, 2026

✔ NPI 1073482014 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in TX · 1231411

3133 E LEMMON AVE, Dallas, TX 75204

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mackenzie Randolph is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 75204 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$88.19 typical visit price

range $57.18 – $172.86

Typical copayment $22.04 (range $14.29 – $43.21)

Most-billed visit code 99203

Established Patient

$100.80 typical visit price

range $18.48 – $141.20

Typical copayment $25.20 (range $4.62 – $35.30)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.