MEDICARE: DESTINEE WILLIAMS RDN

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1548147929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESTINEE WILLIAMS RDN

Provider Business Mailing Address
First Line	:	15402 N 28TH ST UNIT 129
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-7946
Country	:	US
Telephone Number	:	520-909-1626
Fax Number	:

Provider Business Practice Location Address
First Line	:	15402 N 28TH ST UNIT 129
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-7946
Country	:	US
Telephone Number	:	520-909-1626
Fax Number	:

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

Provider Enumeration Date	:	08/19/2025
Last Update Date	:	08/19/2025

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