Healthcare Provider Details

I. General information

NPI: 1750962791
Provider Name (Legal Business Name): DESTINY TORRES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 07/23/2021
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W CHESTNUT ST APT 4
LEITCHFIELD KY
42754-2339
US

IV. Provider business mailing address

400 W CHESTNUT ST APT 4
LEITCHFIELD KY
42754-2339
US

V. Phone/Fax

Practice location:
  • Phone: 270-589-7460
  • Fax:
Mailing address:
  • Phone: 270-589-7460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number2021774P
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number2021774P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: