Individual provider Active NPI

Destany Edwards

  • Speech-Language Pathologist
  • Corbin, KY
National Provider Identifier
1457841249
Registry record updated Jul 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
251043 Issued in KY
Practice address
8706 S US Highway 25
Corbin, KY 40701-4974
Phone
(606) 677-1166
NPI assigned
May 16, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 251043 KY Primary

Addresses

Primary practice location

8706 S US Highway 25
Corbin, KY 40701-4974

Mailing address

432 Boulder Dr
London, KY 40741-8809
Phone (606) 260-7646

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190827002262 KY Practitioner - Qualified Speech Language Pathologist 6204164338 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Speech Language Pathologist
Education
Other, 2018
Medicare assignment
May accept Medicare assignment
Group practices
Brighter Futures Therapy Center LLCGroup PAC ID 2668742107, 11 clinicians

Practice addresses (Care Compare)

303 2ND St
Somerset, KY 42501-2390
Phone (606) 677-1166

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
251043KYMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Brighter Futures Therapy Center, LLC Speech-Language Pathologist CurrentSince Jul 16, 2019 Accepting new patients

Locations

8706 S US Highway 25
Corbin, KY 40701
Phone (606) 258-7035

303 Second St
Somerset, KY 42501
Phone (606) 451-9672

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1526428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562803200000",
    "number": "1457841249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "432 BOULDER DR",
            "city": "LONDON",
            "state": "KY",
            "postal_code": "407418809",
            "telephone_number": "606-260-7646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8706 S US HIGHWAY 25",
            "city": "CORBIN",
            "state": "KY",
            "postal_code": "407014974",
            "telephone_number": "606-677-1166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "DESTANY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-16",
        "last_updated": "2019-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "KY",
            "license": "251043",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Corbin, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.