Provider Demographics
NPI:1205467917
Name:MAYFIELD, DESTINI DAWN (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:DESTINI
Middle Name:DAWN
Last Name:MAYFIELD
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16343 N 151ST AVE
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-1476
Mailing Address - Country:US
Mailing Address - Phone:602-399-9079
Mailing Address - Fax:
Practice Address - Street 1:3101 N CENTRAL AVE STE 183
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-3616
Practice Address - Country:US
Practice Address - Phone:602-399-9079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-31
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ238952363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health