Provider Demographics
NPI:1316660079
Name:CLIFFT, DESTINY
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:
Last Name:CLIFFT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 DAVENPORT RD
Mailing Address - Street 2:
Mailing Address - City:QUINTON
Mailing Address - State:OK
Mailing Address - Zip Code:74561-5021
Mailing Address - Country:US
Mailing Address - Phone:918-916-6622
Mailing Address - Fax:
Practice Address - Street 1:311 S 11TH ST
Practice Address - Street 2:
Practice Address - City:HARTSHORNE
Practice Address - State:OK
Practice Address - Zip Code:74547-4217
Practice Address - Country:US
Practice Address - Phone:918-297-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator