MEDICARE: DESTINY NICOLE FAUGHT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-22-201724	IN

General Provider Information

NPI Number	:	1265186076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESTINY NICOLE FAUGHT

Provider Business Mailing Address
First Line	:	2600 SANDCREST BLVD
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47203-3053
Country	:	US
Telephone Number	:	812-413-9321
Fax Number	:	812-413-9323

Provider Business Practice Location Address
First Line	:	2600 SANDCREST BLVD
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47203-3053
Country	:	US
Telephone Number	:	812-413-9321
Fax Number	:	812-413-9323

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2022
Last Update Date	:	02/10/2022

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Directions to “ DESTINY NICOLE FAUGHT ” Practice Location

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