Provider Demographics
NPI:1912664707
Name:ROGERS, DESTYNI KIRIE
Entity Type:Individual
Prefix:MISS
First Name:DESTYNI
Middle Name:KIRIE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:DESTYNI
Other - Middle Name:KIRIE
Other - Last Name:UNDERWOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:161 JD TOWLES DR
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76087-8654
Mailing Address - Country:US
Mailing Address - Phone:682-900-1444
Mailing Address - Fax:
Practice Address - Street 1:937 HILLTOP DR
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5845
Practice Address - Country:US
Practice Address - Phone:830-358-6382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-29
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician