Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mrs. Bethany N Randolph

Individual provider Registered Dietitian · NPI 1730904251

Mrs. Bethany N Randolph is a Registered Dietitian OR Nutrition Professional in Saint Louis, Missouri. Qualified in 1996, 30 years ago. Practices as a sole proprietor. Licensed in Missouri.

Years since qualifying
30
Licensed in
MO
In the registry since
2024
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Practice location Address checks out

615 S Ballas Rd
Saint Louis, MO 63122-5314
Phone: (314) 251-5550
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Registered Dietitian (primary) Taxonomy 133V00000X · Licence 2001015394 (MO)

Record details

NPI number1730904251
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedNovember 19, 2024
Last updated in NPPESNovember 19, 2024
Certification dateNovember 19, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyREGISTERED DIETITIAN OR NUTRITION PROFESSIONAL
Medical schoolOTHER
Graduated 1996 (30 years in practice)
Accepts Medicare assignment Not indicated
Practice locations3 on file with Medicare

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