Healthcare Provider Details

I. General information

NPI: 1245148808
Provider Name (Legal Business Name): DESTYN WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 STATELINE RD E STE E
SOUTHAVEN MS
38671-8701
US

IV. Provider business mailing address

3361 KNIGHT TRAILS CIR APT 204
MEMPHIS TN
38115-3781
US

V. Phone/Fax

Practice location:
  • Phone: 662-536-6884
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: