Provider Demographics
NPI:1093198053
Name:HOWARD, DESTINY NOEL (MS, RDN, LD, CNSC)
Entity Type:Individual
Prefix:MRS
First Name:DESTINY
Middle Name:NOEL
Last Name:HOWARD
Suffix:
Gender:F
Credentials:MS, RDN, LD, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3126 S BOULEVARD STE 127
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5308
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12051 QUAIL RIDGE CIR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-2195
Practice Address - Country:US
Practice Address - Phone:405-593-8512
Practice Address - Fax:405-509-5541
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2084133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered