Individual
DESTYNI BRANCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
600 HIGHWAY 425 N STE B, MONTICELLO, AR 71655-4020
(870) 224-7100
(870) 224-0373
Mailing address
10025 W MARKHAM ST STE 150, LITTLE ROCK, AR 72205-1416
(501) 663-5473
(501) 661-1812
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
03/29/2018
Last updated
03/29/2018
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