Provider Demographics
NPI:1477337178
Name:WORKMAN, DESTINY NICOLE
Entity Type:Individual
Prefix:
First Name:DESTINY
Middle Name:NICOLE
Last Name:WORKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476 TONEY'S FORK RD
Mailing Address - Street 2:
Mailing Address - City:CLEAR CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:25044
Mailing Address - Country:US
Mailing Address - Phone:304-222-1799
Mailing Address - Fax:
Practice Address - Street 1:476 TONEY'S FORK RD
Practice Address - Street 2:
Practice Address - City:CLEAR CREEK
Practice Address - State:WV
Practice Address - Zip Code:25044
Practice Address - Country:US
Practice Address - Phone:304-222-1799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant