Healthcare Provider Details

I. General information

NPI: 1477497675
Provider Name (Legal Business Name): DESTINY RAWLS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 RIDGEWOOD DR
COLUMBIA MS
39429-2643
US

IV. Provider business mailing address

1915 RIDGEWOOD DR
COLUMBIA MS
39429-2643
US

V. Phone/Fax

Practice location:
  • Phone: 601-522-3787
  • Fax:
Mailing address:
  • Phone: 601-522-3787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: