Healthcare Provider Details

I. General information

NPI: 1801546882
Provider Name (Legal Business Name): DESTINY RAE HOLMES MS,RDN,LD, CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DESTINY RAE MATTHEWS

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17238 BULVERDE RD
SAN ANTONIO TX
78247-2401
US

IV. Provider business mailing address

646 S FLORES ST
SAN ANTONIO TX
78204-1219
US

V. Phone/Fax

Practice location:
  • Phone: 855-481-1149
  • Fax:
Mailing address:
  • Phone: 855-481-1149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT86633
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: