Healthcare Provider Details

I. General information

NPI: 1417510264
Provider Name (Legal Business Name): DESTINY JOY TREVINO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 07/13/2022
Certification Date: 08/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 S FRY RD
KATY TX
77450-2256
US

IV. Provider business mailing address

6102 FLAGG RANCH DR
SPRING TX
77388-2618
US

V. Phone/Fax

Practice location:
  • Phone: 281-559-6441
  • Fax: 281-817-1179
Mailing address:
  • Phone: 832-638-3439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP142076
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number865234
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: