Provider Demographics
NPI:1104645837
Name:KING, DESTINY SLOANE (APRN)
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:SLOANE
Last Name:KING
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:DESTINY
Other - Middle Name:SLOANE
Other - Last Name:BASWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 749495
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9495
Mailing Address - Country:US
Mailing Address - Phone:855-963-2100
Mailing Address - Fax:813-321-1296
Practice Address - Street 1:1 MERCY LN STE 200A
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6457
Practice Address - Country:US
Practice Address - Phone:501-525-4555
Practice Address - Fax:501-525-4685
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR123298363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily