Healthcare Provider Details

I. General information

NPI: 1679269997
Provider Name (Legal Business Name): DESTYNI GOODE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 6TH AVE S
BIRMINGHAM AL
35233-1802
US

IV. Provider business mailing address

307 RIVERCHASE TRL
HOOVER AL
35244-2051
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-4277
  • Fax:
Mailing address:
  • Phone: 256-682-9173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-185986
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number1-185986
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: