Healthcare Provider Details

I. General information

NPI: 1457175788
Provider Name (Legal Business Name): DESTINY J HEFLING
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 N ARSENAL AVE
INDIANAPOLIS IN
46201-3808
US

IV. Provider business mailing address

6189 W JOHN L MODGLIN DR STE 101
GREENFIELD IN
46140-9364
US

V. Phone/Fax

Practice location:
  • Phone: 317-632-0123
  • Fax: 317-423-0608
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71016023A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: