Healthcare Provider Details

I. General information

NPI: 1053221648
Provider Name (Legal Business Name): DESTINY SABOL BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DESTINY REDDEN BSN

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 INDUSTRIAL PARK RD
MAXWELTON WV
24957-8066
US

IV. Provider business mailing address

131 WELLNESS DR
SUMMERSVILLE WV
26651-5402
US

V. Phone/Fax

Practice location:
  • Phone: 304-497-0500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number119634
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: