Provider Demographics
NPI:1144190737
Name:RANDLE, AUDRIANNA
Entity type:Individual
Prefix:
First Name:AUDRIANNA
Middle Name:
Last Name:RANDLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10044 JACKS RD
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39773-9354
Mailing Address - Country:US
Mailing Address - Phone:662-295-7913
Mailing Address - Fax:
Practice Address - Street 1:10044 JACKS RD
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:MS
Practice Address - Zip Code:39773-9354
Practice Address - Country:US
Practice Address - Phone:662-295-7913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-08
Last Update Date:2025-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS412769235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty