Destiny Grace Broom, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

906701 Issued in MS

Practice address

134 Marion Ave
McComb, MS 39648-3620

Phone

(601) 300-8252

NPI assigned

Jun 8, 2024

Last updated

Oct 1, 2024By 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 MS, LA2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Neuro Care of Louisiana, LLCGroup PAC ID 0143514083, 7 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Luke Home Health Services Home health agency, McComb, MS, CCN 257124
• Southwest Ms Regional Medical Center Hospital, McComb, MS, CCN 250097
• King's Daughters Medical Center-Brookhaven Hospital, Brookhaven, MS, CCN 250057
• Merit Health Natchez Hospital, Natchez, MS, CCN 250084
• Field Health System Hospital, Centreville, MS, CCN 251309
• Forrest General Hospital Hospital, Hattiesburg, MS, CCN 250078

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/HBABBD

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.

• Neuro Care of Louisiana, LLC

  • Neurology Physician
  • Covington, LA
  • NPI 1073962528

  MS

  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Field Memorial Community Hospital

  dba Field Health System

  • Critical Access Hospital
  • Centreville, MS
  • NPI 1770574048
  Care Compare affiliation
• Forrest County General Hospital

  • General Acute Care Hospital
  • Hattiesburg, MS
  • NPI 1225041809
  Care Compare affiliation
• King's Daughters Medical Center

  • General Acute Care Hospital
  • Brookhaven, MS
  • NPI 1972503464
  Care Compare affiliation
• Natchez Hospital Company LLC

  dba Merit Health Natchez

  • General Acute Care Hospital
  • Natchez, MS
  • NPI 1164821559
  Care Compare affiliation
• Southwest Mississippi Regional Medical Center

  • General Acute Care Hospital
  • McComb, MS
  • NPI 1407805971
  Care Compare affiliation
• St. Luke Home Health Services, LLC

  • Home Health Agency
  • McComb, MS
  • NPI 1255401642
  Care Compare affiliation

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

{
    "created_epoch": "1717804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727740800000",
    "number": "1982446225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 MARION AVE",
            "city": "MCCOMB",
            "state": "MS",
            "postal_code": "396483620",
            "telephone_number": "985-805-2555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 MARION AVE",
            "city": "MCCOMB",
            "state": "MS",
            "postal_code": "396483620",
            "telephone_number": "601-300-8252"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "112 Sheffield Loop Ste B",
            "address_purpose": "LOCATION",
            "city": "Hattiesburg",
            "state": "MS",
            "postal_code": "394021406",
            "country_code": "US",
            "telephone_number": "601-501-7203",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROOM",
        "first_name": "DESTINY",
        "middle_name": "GRACE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-08",
        "last_updated": "2024-10-01",
        "certification_date": "2024-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "906701",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Catina Brigss
• Jackie Eugene Brister, F.N.P.
• Tonya Brister, FNP-C
• James Murray Brock Jr., M.D.
• Ursula Shene Brooks-Clemons, FPMHNP
• Issac Duane Broussard, M.D.
• Rita Brown-Bobkoskie, CMHT
• Cherie Elizabeth Brown, RPH
• Gwendolyn Michelle Brown, CNA
• Laterra Brown, PMHNP-BC

• Family Nurse Practitioner in McComb, MS
• Providers in McComb, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2024; 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.
• 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.