Provider Demographics
NPI:1043702343
Name:GAYMAN, DELIA A (NP)
Entity type:Individual
Prefix:
First Name:DELIA
Middle Name:A
Last Name:GAYMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DELIA
Other - Middle Name:A
Other - Last Name:GROLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2115 S FREMONT AVE STE 3000
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2215
Mailing Address - Country:US
Mailing Address - Phone:417-820-9123
Mailing Address - Fax:
Practice Address - Street 1:2115 S FREMONT AVE STE 3000
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2215
Practice Address - Country:US
Practice Address - Phone:417-820-9123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-01
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018020173363LF0000X
MO2011021108163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse