Destiny Astin Manner

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

3959 Stadium Way Dept 3913
Ogden, UT 84408-0001

Phone

(801) 921-3289

NPI assigned

Jan 27, 2025

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 UT

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

Physician Assistant

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.

• Numinus Wellness Ut Inc

  • Psychiatry Physician
  • Springville, UT
  • NPI 1265092282
  Medicare reassignment

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

{
    "created_epoch": "1737936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737936000000",
    "number": "1841003787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3959 STADIUM WAY DEPT 3913",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844080001",
            "telephone_number": "801-921-3289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3959 STADIUM WAY DEPT 3913",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844080001",
            "telephone_number": "801-921-3289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANNER",
        "first_name": "DESTINY",
        "middle_name": "ASTIN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-01-27",
        "last_updated": "2025-01-27",
        "certification_date": "2025-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lee Jeppson Malan, MD
• Matthew Wendall Malan, DMD
• Lauren Whitehouse Malik, PT
• Zoe Malnar, RN
• Karina Diane Mandell
• Bronwyn Tayler Manning
• Theresa J Manning, OTR/L
• Tamara Manore
• Justin W Mansfield, M.D.
• Zackery Dennis Mansfield

• Physician Assistant in Ogden, UT
• Providers in Ogden, UT by specialty
• Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2025; 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.