Provider Demographics
NPI:1427607019
Name:DESTINY BOUND, LLC
Entity Type:Organization
Organization Name:DESTINY BOUND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:FEDOSKY
Authorized Official - Suffix:
Authorized Official - Credentials:CPM, LLM
Authorized Official - Phone:479-409-5479
Mailing Address - Street 1:3825 N SALEM ROAD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704
Mailing Address - Country:US
Mailing Address - Phone:479-409-5479
Mailing Address - Fax:
Practice Address - Street 1:3825 N SALEM ROAD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704
Practice Address - Country:US
Practice Address - Phone:479-409-5479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty