Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mrs. Destiny Grace Petrowich, PA-C

Individual provider Physician Assistant · NPI 1063037711

Mrs. Destiny Grace Petrowich, PA-C is a Physician Assistant in Marion, Illinois. Graduated from Southern Illinois University School of Medicine in 2020, 6 years ago. Works from 2 locations and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
6
Trained at
Southern Illinois University School of Medicine
Licensed in
IL
In the registry since
2020
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

1603 W Kimmel St
Marion, IL 62959-1008
Phone: (618) 993-2906
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 310 W Plaza Dr, Carterville, IL 62918-1980 — (618) 985-4344

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 085.007902 (IL)

Record details

NPI number1063037711
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJune 9, 2020
Last updated in NPPESSeptember 24, 2022
Certification dateSeptember 24, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolSOUTHERN ILLINOIS UNIVERSITY SCHOOL OF MEDICINE
Graduated 2020 (6 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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