Provider Demographics
NPI:1265831838
Name:STORY, DELIA MARY HEARN (DNP, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:DELIA
Middle Name:MARY HEARN
Last Name:STORY
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 N GILBERT RD, #2, PMB188
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-5117
Mailing Address - Country:US
Mailing Address - Phone:480-227-4426
Mailing Address - Fax:480-834-3606
Practice Address - Street 1:1106 N GILBERT RD, #2, PMB188
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-5117
Practice Address - Country:US
Practice Address - Phone:480-227-4426
Practice Address - Fax:480-834-3606
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTAP5761363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ969411Medicaid
AZ969411Medicaid