Destiny Medical Practice LLC

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

Legal business name

DESTINY MEDICAL PRACTICE LLC

Practice address

10 Amara LN
Westampton, NJ 08060-5753

Phone

(914) 204-3348

NPI assigned

Oct 20, 2020

Organization subpart

No

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

Authorized official

Name

Vida-Lynn Asiamah- Asare, APN

Title

Owner

Phone

(917) 204-3333

Specialties & licenses 1

Addresses

Other names 1

• DESTINY MEDICAL PRACTICE LLC Doing business as

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

{
    "created_epoch": "1603152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606176000000",
    "number": "1669071775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 544",
            "city": "RANCOCAS",
            "state": "NJ",
            "postal_code": "080730544",
            "telephone_number": "609-496-3494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 AMARA LN",
            "city": "WESTAMPTON",
            "state": "NJ",
            "postal_code": "080605753",
            "telephone_number": "914-204-3348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESTINY MEDICAL PRACTICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-20",
        "last_updated": "2020-11-24",
        "certification_date": "2020-11-24",
        "status": "A",
        "authorized_official_last_name": "ASIAMAH- ASARE",
        "authorized_official_first_name": "VIDA-LYNN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "917-204-3333",
        "authorized_official_credential": "APN"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DESTINY MEDICAL PRACTICE LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "DESTINY MEDICAL PRACTICE LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Chelsea Derby
• Alexander Deshields
• Rondia Deshields
• Alyssa Destefano
• Gabriella Destefano
• Jason A Devalerio
• Jacqueline Deveney
• Patricia Marie Devlin
• Mamadou Diakite
• Erica Samantha Diaz

• Adult Health Nurse Practitioner in Westampton, NJ
• Providers in Westampton, NJ by specialty
• Adult Health Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.