Healthcare Provider Details

I. General information

NPI: 1699349191
Provider Name (Legal Business Name): PARIS DELANEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10004 KENNERLY RD STE 230A
SAINT LOUIS MO
63128-2181
US

IV. Provider business mailing address

PO BOX 776084
CHICAGO IL
60677-6084
US

V. Phone/Fax

Practice location:
  • Phone: 314-525-4100
  • Fax:
Mailing address:
  • Phone: 314-364-7586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2026041097
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: