DESTINY CLARK NPI 1700578010

NPI Information

  • NPI: 1700578010
  • Provider Name: DESTINY CLARK
  • Classification: Prosthetic/Orthotic Supplier - 335E00000X
  • Entity Type: Individual
  • Address: 6811 OLD CANTON RD APT 3305
    RIDGELAND, MS
    ZIP 39157
  • Phone: (769) 231-7366

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NPI Details

Destiny Clark is a prosthetic orthotic supplier in Ridgeland, MS. The provider is an organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition. Destiny Clark NPI is 1700578010. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

6811 OLD CANTON RD APT 3305
RIDGELAND, MS
ZIP 39157-247
Phone: (769) 231-7366

The enumeration date for this NPI number is 5/24/2023 and was last updated on 5/24/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1335E00000XProsthetic/Orthotic SupplierMISSISSIPPIYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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