Provider Demographics
NPI:1093697773
Name:RICE, DESTINY M (BHCM, PRS)
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:M
Last Name:RICE
Suffix:
Gender:F
Credentials:BHCM, PRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 156
Mailing Address - Street 2:
Mailing Address - City:TATUMS
Mailing Address - State:OK
Mailing Address - Zip Code:73487-0156
Mailing Address - Country:US
Mailing Address - Phone:405-888-4027
Mailing Address - Fax:
Practice Address - Street 1:401 S MERIDIAN AVE STE 101
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73108-1013
Practice Address - Country:US
Practice Address - Phone:405-888-4027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No374U00000XNursing Service Related ProvidersHome Health Aide