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General NPI Number Information
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NPI Number | 1316500366
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Entity Type | Individual
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Provider Name | MS. DESTINY PRATT WRIGHT
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Gender | Female
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Dates
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Enumeration Date | 04/16/2019
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Last Update Date | 08/13/2020
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Provider Practice Location Address
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Address Line | 846 BAKER AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32209-7543
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Country | US
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Telephone | 904-322-3706
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Fax |
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Provider Business Mailing Address
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Address Line | 846 BAKER AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32209-7543
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Country | US
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Telephone | 904-322-3706
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | FL
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