Provider Demographics
NPI:1043537814
Name:RANDLE, JULIE A
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:A
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 1:601 GREENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-1631
Mailing Address - Country:US
Mailing Address - Phone:405-623-9072
Mailing Address - Fax:
Practice Address - Street 1:5005 N PENN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-8886
Practice Address - Country:US
Practice Address - Phone:405-753-4269
Practice Address - Fax:405-753-4270
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)