| Destiny Total Healthcare, Pllc | |
|
407 Fremont Street Burgaw NC 28425 | |
| (910) 900-5411 | |
| Not Available |
| Full Name | Destiny Total Healthcare, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 407 Fremont Street, Burgaw, North Carolina |
| Authorized Official Name and Position | Tonia Whitley Gray (OWNER) |
| Authorized Official Contact | 9102593489 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Destiny Total Healthcare, Pllc 407 E Fremont St Burgaw NC 28425-5129 Ph: (910) 259-3489 | Destiny Total Healthcare, Pllc 407 Fremont Street Burgaw NC 28425 Ph: (910) 900-5411 |
| NPI Number | 1487251807 |
|---|---|
| Provider Enumeration Date | 10/08/2020 |
| Last Update Date | 11/30/2020 |
| Medicare PECOS PAC ID | 9931510013 |
|---|---|
| Medicare Enrollment ID | O20201120001120 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487251807 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Larisa Rollins King |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699314971 PECOS PAC ID: 3173952611 Enrollment ID: I20200403000194 |
| Provider Name | Tonia Whitley Gray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659891232 PECOS PAC ID: 1759792831 Enrollment ID: I20201120001237 |
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