Active NPI
Jaylyn Denise Randles, CPSW, CHW
- Community Health Worker
- Gallup, NM
National Provider Identifier
1962269118
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- S3-1615
- Practice address
- 2111 College Dr
Gallup, NM 87301-5600 - Phone
- (505) 879-5655
- NPI assigned
- Mar 4, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | 1456 | NM | |
| Doula | 374J00000X | 0019-2025 | NM | |
| Community Health Worker | 172V00000X | S3-1615 | NM | Primary |
Addresses
Primary practice location
2111 College Dr
Gallup, NM 87301-5600
Mailing address
2111 College Dr
Gallup, NM 87301-5600
Phone (505) 879-5655
Other names 1
- Jaylyn Denise Ellis
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Care Compare profile
Medicare Care Compare- Specialty
- Undefined Non-Physician Type (Specify)
- Education
- Other, 2024
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
2111 College Dr
Gallup, NM 87301-5600
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S3-1615 | NM | MD | Community Health Worker |
| 1456 | NM | MD | Peer Specialist |
| 0019-2025 | NM | MD | Doula |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1709510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1748476800000",
"number": "1962269118",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2111 COLLEGE DR",
"city": "GALLUP",
"state": "NM",
"postal_code": "873015600",
"telephone_number": "505-879-5655"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2111 COLLEGE DR",
"city": "GALLUP",
"state": "NM",
"postal_code": "873015600",
"telephone_number": "505-879-5655"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDLES",
"first_name": "JAYLYN",
"middle_name": "DENISE",
"name_prefix": "Ms.",
"credential": "CPSW, CHW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-03-04",
"last_updated": "2025-05-29",
"certification_date": "2025-05-29",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "NM",
"license": "1456",
"primary": false
},
{
"code": "374J00000X",
"taxonomy_group": "",
"desc": "Doula",
"state": "NM",
"license": "0019-2025",
"primary": false
},
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "NM",
"license": "S3-1615",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JAYLYN",
"last_name": "ELLIS",
"middle_name": "DENISE",
"credential": "CPSW",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Gallup, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.