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Organization
DESTINY URGENT AND PRIMARY CARE CLINIC. LLC
Active
Organization
DESTINY URGENT AND PRIMARY CARE CLINIC. LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERNEST KAARA MAINA FNP (OWNER/PROVIDER)
(417) 317-3388
Entity
Organization
Contact information
Practice address
1818 N HIGHWAY 66 STE B, CATOOSA, OK 74015-3052
(417) 317-3388
Mailing address
1000 W ELMIRA ST, BROKEN ARROW, OK 74012-0872
(417) 317-3388
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
NULL
261QM1300X
Multi-Specialty Clinic/Center
—
NULL
261QP2300X
Primary Care Clinic/Center
—
NULL
261QU0200X
Urgent Care Clinic/Center
—
NULL
363L00000X
Nurse Practitioner
Primary
—
NULL
363L00000X
Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1740751445
NPI#
OK
Enumeration date
04/05/2021
Last updated
04/22/2021
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