Healthcare Provider Details

I. General information

NPI: 1306600127
Provider Name (Legal Business Name): DESTINEE HIMES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 05/31/2025
Certification Date: 05/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 OMNI BLVD STE 110
NEWPORT NEWS VA
23606-4430
US

IV. Provider business mailing address

934 NICKLAUS DR
NEWPORT NEWS VA
23602-8895
US

V. Phone/Fax

Practice location:
  • Phone: 757-223-9794
  • Fax:
Mailing address:
  • Phone: 757-320-6982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0001280068
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: