MEDICARE: DESTINY ELLISON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	251E00000X	Home Health Agency	AR
2	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care	AR
3	385H00000X	Respite Care	AR

General Provider Information

NPI Number	:	1053285999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESTINY ELLISON

Provider Business Mailing Address
First Line	:	2628 GREEN VALLEY DR
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-4983
Country	:	US
Telephone Number	:	501-413-2167
Fax Number	:

Provider Business Practice Location Address
First Line	:	9715 LABETTE DR
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-6703
Country	:	US
Telephone Number	:	501-413-2167
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2025
Last Update Date	:	10/02/2025

Similar Medicare Providers

1467842211 — KIDZ CONNECTION
Practice Location Address:

5307 JOHN F KENNEDY BLVD
NORTH LITTLE ROCK, AR
72116-6703

Practice Phone: 501-400-8663
Practice Fax:

1205207040 — MR. MATTHEW LAWSON WOLFF
Practice Location Address:

5307 JFK BLVD
NORTH LITTLE ROCK, AR
72116-6703

Practice Phone: 501-392-6201
Practice Fax:

1295190569 — MRS. CHRISTINA FRAKES M.S., CF-SLP
Practice Location Address:

5307 JFK BLVD
NORTH LITTLE ROCK, AR
72116-6703

Practice Phone: 501-392-6102
Practice Fax:

1740502434 — DR. JERRY JOHN POKORNEY D.C.
Practice Location Address:

3105 ROCK HILL CHURCH RD , SUITE 101
CONCORD, NC
28027-6703

Practice Phone: 404-421-2562
Practice Fax:

1710286570 — TAMERA WALLER-DRYE
Practice Location Address:

3105 ROCK HILL CHURCH RD , SUITE 102
CONCORD, NC
28027-6703

Practice Phone: 980-621-0889
Practice Fax:

1891064267 — MRS. KATRINA LYNN BRENNAN LMBT MMP
Practice Location Address:

3105 ROCK HILL CHURCH RD , SUITE 102
CONCORD, NC
28027-6703

Practice Phone: 704-960-9961
Practice Fax:

Directions to “ DESTINY ELLISON ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.