Provider Demographics
NPI:1821400581
Name:DELK, GWEN E (APRN, FNP)
Entity Type:Individual
Prefix:
First Name:GWEN
Middle Name:E
Last Name:DELK
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 KENT ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-5858
Mailing Address - Country:US
Mailing Address - Phone:432-687-2273
Mailing Address - Fax:512-206-0696
Practice Address - Street 1:3304 LAUREL CIR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-5721
Practice Address - Country:US
Practice Address - Phone:432-687-2273
Practice Address - Fax:512-206-0696
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125282363LF0000X
GARN212354363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily