Provider Demographics
NPI:1043865447
Name:MCFADDEN, DESTINY RICKEL (RN)
Entity Type:Individual
Prefix:
First Name:DESTINY
Middle Name:RICKEL
Last Name:MCFADDEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 N SAINT PAUL ST STE 3100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-3923
Mailing Address - Country:US
Mailing Address - Phone:678-599-3395
Mailing Address - Fax:
Practice Address - Street 1:325 N SAINT PAUL ST STE 3100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-3923
Practice Address - Country:US
Practice Address - Phone:678-599-3395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-03
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN279690163W00000X, 163W00000X, 163WD0400X, 163WH0200X, 163WN1003X
133NN1002X, 174H00000X, 175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN1003XNursing Service ProvidersRegistered NurseNutrition Support
Yes163W00000XNursing Service ProvidersRegistered Nurse
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No174H00000XOther Service ProvidersHealth Educator
No175F00000XOther Service ProvidersNaturopath