Provider Demographics
NPI:1710268925
Name:DELAPA, DESTINY BROOK (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:DESTINY
Middle Name:BROOK
Last Name:DELAPA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MISS
Other - First Name:DESTINY
Other - Middle Name:BROOK
Other - Last Name:DAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:422 KINETIC PARK DR
Mailing Address - Street 2:STE B
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701
Mailing Address - Country:US
Mailing Address - Phone:304-523-5100
Mailing Address - Fax:
Practice Address - Street 1:422 KINETIC PARK DR
Practice Address - Street 2:STE B
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701
Practice Address - Country:US
Practice Address - Phone:304-523-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2011006466363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100192550Medicaid
WV1710268925Medicaid
OH0066715Medicaid
WVWV1250AMedicare PIN