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Destination Life LLC-S

Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist in Ellisville, MS · enumerated 2020 · authorized official Zemelda Carr, Adm.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1023625894

Verified

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Registry record

Entity type Organization (Type 2)
Legal business name Destination Life LLC-S
Other name <Unavail>
Practice address 7 Jonathan Way, Ellisville, MS, 39437
Phone (817) 473-1312
Fax (866) 990-2813
Enumeration date Sep 25, 2020
Last updated in NPPES Jul 30, 2021

Taxonomy & classification

1041C0700X Clinical Social Worker Behavioral Health & Social Service Providers Secondary
163WP0807X Child & Adolescent Psychiatric/Mental Health Registered Nurse Nursing Service Providers Secondary
225X00000X Occupational Therapist Respiratory, Developmental, Rehabilitative and Restorative Service Providers Secondary
225XM0800X Mental Health Occupational Therapist Respiratory, Developmental, Rehabilitative and Restorative Service Providers Secondary
261QP2300X Primary Care Clinic/Center Ambulatory Health Care Facilities Secondary
261QR0401X Comprehensive Outpatient Rehabilitation Facility (CORF) Ambulatory Health Care Facilities Secondary
291U00000X Clinical Medical Laboratory Laboratories Secondary
363L00000X Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers Secondary
363LC1500X Community Health Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers Secondary
363LF0000X Family Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers Secondary
363LP0808X Psychiatric/Mental Health Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers Secondary
363LW0102X Women's Health Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers Secondary
364S00000X Clinical Nurse Specialist Physician Assistants & Advanced Practice Nursing Providers Secondary
364SP0807X Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist Physician Assistants & Advanced Practice Nursing Providers Primary
364SP0808X Psychiatric/Mental Health Clinical Nurse Specialist Physician Assistants & Advanced Practice Nursing Providers Secondary

Authorized official

Name Zemelda Carr
Title Adm
Phone (817) 473-1312

Other identifiers

Identifier Type State Issuer
03320311 Medicaid MS -
25D2200016 Other MS CLIA
1C5803 Other TX GROUP

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

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Frequently asked questions

What is the NPI number for Destination Life LLC-S?
The NPI for Destination Life LLC-S is 1023625894, a Type 2 (organization) record in the CMS NPPES registry.
Who is the authorized official for Destination Life LLC-S?
NPPES lists Zemelda Carr (Adm) as the authorized official for this organization.

Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2021-07-30.