Healthcare Provider Details

I. General information

NPI: 1245508860
Provider Name (Legal Business Name): DELICIA VANTERPOOL DNP, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DELICIA HODGE DNP, NP-C

II. Dates (important events)

Enumeration Date: 12/09/2011
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8045 HIGHWAY 72 W STE 200
MADISON AL
35758-9564
US

IV. Provider business mailing address

PO BOX 11275
HUNTSVILLE AL
35814-1275
US

V. Phone/Fax

Practice location:
  • Phone: 256-947-2285
  • Fax: 800-293-3860
Mailing address:
  • Phone: 256-947-2285
  • Fax: 800-293-3860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-114022
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: