Provider Demographics
NPI:1891427704
Name:MYERS, DESTANY S (IBCLC, CLC, CLSP)
Entity type:Individual
Prefix:
First Name:DESTANY
Middle Name:S
Last Name:MYERS
Suffix:
Gender:F
Credentials:IBCLC, CLC, CLSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 GRANDVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-8712
Mailing Address - Country:US
Mailing Address - Phone:303-549-0325
Mailing Address - Fax:
Practice Address - Street 1:517 GRANDVIEW BLVD
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-8712
Practice Address - Country:US
Practice Address - Phone:303-549-0325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-29
Last Update Date:2025-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXALPP-333912101Y00000X
L-319195174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No101Y00000XBehavioral Health & Social Service ProvidersCounselor