Healthcare Provider Details

I. General information

NPI: 1932963360
Provider Name (Legal Business Name): DELANA SHOEMAKE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DELANA VAUGHAN

II. Dates (important events)

Enumeration Date: 02/07/2024
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1059 BARTON DR
FORDLAND MO
65652-7350
US

IV. Provider business mailing address

1059 BARTON DR
FORDLAND MO
65652-7350
US

V. Phone/Fax

Practice location:
  • Phone: 417-767-2273
  • Fax: 417-767-4054
Mailing address:
  • Phone: 417-767-2273
  • Fax: 417-767-4054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2024004874
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: