Healthcare Provider Details

I. General information

NPI: 1124916135
Provider Name (Legal Business Name): DESTINY BRENNAN RD, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 PARKER DR
PRESCOTT AZ
86303-5555
US

IV. Provider business mailing address

188 PARKER DR
PRESCOTT AZ
86303-5555
US

V. Phone/Fax

Practice location:
  • Phone: 928-925-5857
  • Fax:
Mailing address:
  • Phone: 928-925-5857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number959341
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN272552
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: