Healthcare Provider Details

I. General information

NPI: 1245902279
Provider Name (Legal Business Name): DESTINY PRICE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 CITY AVE N
RIPLEY MS
38663-1102
US

IV. Provider business mailing address

69A COUNTY ROAD 301
CORINTH MS
38834-8828
US

V. Phone/Fax

Practice location:
  • Phone: 662-993-9336
  • Fax: 662-993-9338
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number904886
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: