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NPI Code Detail

MEDICARE: DESTIN JAMALL MARTIN

MEDICARE: DESTIN JAMALL MARTIN
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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerAPRN.CNP.0042405OH

General Provider Information

NPI Number : 1598699688
Entity Type Code : Individual
Provider Name (Legal Business Name) : DESTIN JAMALL MARTIN
Provider Business Mailing Address
First Line : 2285 CREEK VIEW PL
Second Line :
City : GROVE CITY
State : OH
Zip : 43123-4507
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2285 CREEK VIEW PL
Second Line :
City : GROVE CITY
State : OH
Zip : 43123-4507
Country : US
Telephone Number : 567-202-5530
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2026
Last Update Date : 06/11/2026

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Directions to “ DESTIN JAMALL MARTIN ” Practice Location

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