Destiny Ibrom, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP136422 Issued in TX

Practice address

1200 N Virginia St
Port Lavaca, TX 77979-2507

Phone

(361) 552-6721

NPI assigned

Feb 5, 2018

Last updated

Nov 1, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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

• Port Lavaca Clinic Associates PA

  • Family Medicine Physician
  • Port Lavaca, TX
  • NPI 1144262957
  Medicare reassignment
• Regional Employee Assistance Program Inc

  • Cardiovascular Disease Physician
  • Abilene, TX
  • NPI 1073575585
  NPD
• Regional Employee Assistance Program Inc

  • Internal Medicine Physician
  • Victoria, TX
  • NPI 1215999511
  NPD
• Regional Employee Assistance Program Inc

  • Family Medicine Physician
  • Corsicana, TX
  • NPI 1649232984
  NPD
• Citizens Medical Center County of Victoria

  • General Acute Care Hospital
  • Victoria, TX
  • NPI 1124052162
  NPD (past)

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

{
    "created_epoch": "1517788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572566400000",
    "number": "1487153573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 N VIRGINIA ST",
            "city": "PORT LAVACA",
            "state": "TX",
            "postal_code": "779792507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 N VIRGINIA ST",
            "city": "PORT LAVACA",
            "state": "TX",
            "postal_code": "779792507",
            "telephone_number": "361-552-6721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBROM",
        "first_name": "DESTINY",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-05",
        "last_updated": "2019-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP136422",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• H-E-B, LP (HEB Pharmacy #434)
• Jaclyn Hartl, M.ED, LPC - S
• Diana Hoover, LPC
• Clare Horadam, PTA
• Mabel Allene Hunt, RPH
• Joseph Dillon Jenkins, D.O.
• Kestler Chiropractic Clinic,LLC
• Bryan Claude Kestler, D.C.
• Shaukat Ali Khan
• Chrisandra L Kovarek, LCSW-S

• Family Nurse Practitioner in Port Lavaca, TX
• Providers in Port Lavaca, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.