Healthcare Provider Details

I. General information

NPI: 1548187461
Provider Name (Legal Business Name): DESTINI REKALE WATTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 LEESTOWN RD
LEXINGTON KY
40511-1052
US

IV. Provider business mailing address

147 RANSOM TRCE
GEORGETOWN KY
40324-2093
US

V. Phone/Fax

Practice location:
  • Phone: 859-233-4511
  • Fax:
Mailing address:
  • Phone: 606-594-5315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4060604
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: