Provider Demographics
NPI:1689944522
Name:IRISH, DESTINI (BHRS)
Entity Type:Individual
Prefix:
First Name:DESTINI
Middle Name:
Last Name:IRISH
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9210 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-4982
Mailing Address - Country:US
Mailing Address - Phone:405-512-3330
Mailing Address - Fax:
Practice Address - Street 1:9210 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-4982
Practice Address - Country:US
Practice Address - Phone:405-512-3330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management