Provider Demographics
NPI:1124916135
Name:BRENNAN, DESTINY (RD)
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 PARKER DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-5555
Mailing Address - Country:US
Mailing Address - Phone:928-925-5857
Mailing Address - Fax:
Practice Address - Street 1:188 PARKER DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-5555
Practice Address - Country:US
Practice Address - Phone:928-925-5857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA959341133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered