Healthcare Provider Details

I. General information

NPI: 1811810104
Provider Name (Legal Business Name): DESTINY RAYNE BURT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 NORTHGATE DR
IOWA CITY IA
52245-9509
US

IV. Provider business mailing address

24248 VIEJAS GRADE RD
DESCANSO CA
91916-9502
US

V. Phone/Fax

Practice location:
  • Phone: 131-938-4722
  • Fax:
Mailing address:
  • Phone: 619-873-7714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA193102
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: