Provider Demographics
NPI:1245508860
Name:VANTERPOOL, DELICIA (DNP, NP-C)
Entity type:Individual
Prefix:DR
First Name:DELICIA
Middle Name:
Last Name:VANTERPOOL
Suffix:
Gender:F
Credentials:DNP, NP-C
Other - Prefix:DR
Other - First Name:DELICIA
Other - Middle Name:
Other - Last Name:HODGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, NP-C
Mailing Address - Street 1:PO BOX 11275
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35814-1275
Mailing Address - Country:US
Mailing Address - Phone:256-947-2285
Mailing Address - Fax:800-293-3860
Practice Address - Street 1:8045 HIGHWAY 72 W STE 200
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-9564
Practice Address - Country:US
Practice Address - Phone:256-947-2285
Practice Address - Fax:800-293-3860
Is Sole Proprietor?:No
Enumeration Date:2011-12-09
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-114022363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1021504183Medicare PIN