MRS. BETHANY N RANDOLPH
NPI 1730904251
Dietitian, Registered in Saint Louis, MO

Q: What is Bethany Randolph's NPI number?

The NPI number for Bethany Randolph is 1730904251. It was assigned to this individual provider in the NPPES registry on November 19, 2024.

Q: What is Bethany Randolph's specialty?

The primary specialty registered for this NPI is Dietitian, Registered with taxonomy code 133V00000X.

Q: When was this NPI record last updated?

The NPPES record for Bethany Randolph was last updated on November 19, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since November 19, 2024

615 S BALLAS RD, SAINT LOUIS, MO 63122(314) 251-5550 Get Directions Write a Review

NPPES record last updated: November 19, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Mrs. Bethany N Randolph NPPES

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

MRS. BETHANY N RANDOLPH (NPI 1730904251) is an individual dietitian, registered in Saint Louis, Missouri, licensed in Missouri (2001015394) and active in the NPI registry since November 2024. She is a graduate of Other (1996).

NPPES Registry Identity

NPI1730904251

Entity TypeIndividualFemale

Primary Taxonomy133V00000X

Provider Legal NameMRS. BETHANY N RANDOLPH

Location Address615 S BALLAS RDSaint Louis, MO 63122-5314

Mailing Address615 S Ballas RdSaint Louis, MO 63122-5314 · (314) 251-5550

Phone(314) 251-5550

Sole ProprietorYes

Medical School CMSOtherGraduated 1996

Enumeration DateNovember 19, 2024

NPPES CertifiedNovember 19, 2024

✔ NPI 1730904251 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDietitian, RegisteredDietary & Nutritional Service Providers

Taxonomy Code133V00000X

License✔ Licensed in MO · 2001015394

Definition

A Registered Dietitian (RD)/Registered Dietitian Nutritionist (RDN) is an individual uniquely trained in the science of nutrition and practice of dietetics to design and provide medical nutrition therapy (MNT) and other evidence-based applications of the Nutrition Care Process (NCP) that exemplify the profession's systematic approach to providing high quality nutrition care. Registered dietitians provide MNT for the purpose of disease prevention or management, or to treat or rehabilitate an illness, injury, or condition, with the use of specific, indicated physical and cognitive nutrition care services comprised of one or more of the following aspects of the NCP: nutrition assessment/reassessment, nutrition diagnosis, nutrition intervention (e.g., nutrition counseling, therapeutic diet ordering, and nutrition education) and nutrition monitoring and evaluation.

615 S BALLAS RD, Saint Louis, MO 63122

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Home State Health, Ambetter from Sunflower Health Plan and more.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

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

PECOS PAC ID5193223170

PECOS Enrollment IDI20250808002577

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. AMJAD TAHA M.D.

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