Individual
MS. JAYLYN DENISE RANDLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPSW, CHW
Contact information
Practice address
2111 COLLEGE DR, GALLUP, NM 87301-5600
(505) 879-5655
Mailing address
2111 COLLEGE DR, GALLUP, NM 87301-5600
(505) 879-5655
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
S3-1615
NM
175T00000X
Peer Specialist
1456
NM
374J00000X
Doula
0019-2025
NM
Other
Enumeration date
03/04/2024
Last updated
05/29/2025
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