Healthcare Provider Details

I. General information

NPI: 1003312042
Provider Name (Legal Business Name): DESTINEE RENEE OGEA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2018
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MEDICAL CENTER DR STE C
DECATUR TX
76234-3844
US

IV. Provider business mailing address

800 MEDICAL CENTER DR STE C
DECATUR TX
76234-3844
US

V. Phone/Fax

Practice location:
  • Phone: 940-626-2110
  • Fax: 940-626-2113
Mailing address:
  • Phone: 940-626-2110
  • Fax: 940-626-2113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP137195
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN11016195
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: