Healthcare Provider Details

I. General information

NPI: 1043702343
Provider Name (Legal Business Name): DELIA A GAYMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DELIA A GROLL NP

II. Dates (important events)

Enumeration Date: 06/01/2018
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 S FREMONT AVE STE 3000
SPRINGFIELD MO
65804-2215
US

IV. Provider business mailing address

2115 S FREMONT AVE STE 3000
SPRINGFIELD MO
65804-2215
US

V. Phone/Fax

Practice location:
  • Phone: 417-820-9123
  • Fax:
Mailing address:
  • Phone: 417-820-9123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2018020173
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2011021108
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: