Individual
DESTINY L ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2000 E 15TH ST STE 400A, EDMOND, OK 73013-6673
(405) 692-1557
Mailing address
2000 E 15TH ST STE 400A, EDMOND, OK 73013-6673
(405) 341-1697
(405) 341-2672
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
4412
OK
Other
Enumeration date
10/29/2020
Last updated
06/23/2025
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