Provider Demographics
NPI:1902385164
Name:COAKLEY, DESTINY NICOLE
Entity Type:Individual
Prefix:
First Name:DESTINY
Middle Name:NICOLE
Last Name:COAKLEY
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 1:1027 16TH ST NE APT 2
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-2971
Mailing Address - Country:US
Mailing Address - Phone:202-597-3341
Mailing Address - Fax:
Practice Address - Street 1:1027 16TH ST NE APT 2
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-2971
Practice Address - Country:US
Practice Address - Phone:202-597-3341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant