Provider Demographics
NPI:1548051428
Name:RANDLE, JESSICA S (RBT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:S
Last Name:RANDLE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4813 GAUTIER ST
Mailing Address - Street 2:
Mailing Address - City:MOSS POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39563-3403
Mailing Address - Country:US
Mailing Address - Phone:228-934-8024
Mailing Address - Fax:
Practice Address - Street 1:283 DEBUYS RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-2800
Practice Address - Country:US
Practice Address - Phone:228-731-3500
Practice Address - Fax:866-625-0559
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician