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NPI Code Detail

MEDICARE: DESTINY FAITH MOOMEY

MEDICARE: DESTINY FAITH MOOMEY
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1710757976
Entity Type Code : Individual
Provider Name (Legal Business Name) : DESTINY FAITH MOOMEY
Provider Business Mailing Address
First Line : 510 E MEMORIAL RD
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73114-2229
Country : US
Telephone Number : 405-577-1411
Fax Number :
Provider Business Practice Location Address
First Line : 510 E MEMORIAL RD
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73114-2229
Country : US
Telephone Number : 405-577-1411
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2024
Last Update Date : 09/26/2024

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Directions to “ DESTINY FAITH MOOMEY ” Practice Location

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