Basic Information
| Provider Information | |||||||||
| NPI: | 1013344589 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAWL | ||||||||
| FirstName: | DELICIA | ||||||||
| MiddleName: | C. | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2770 S 9TH ST | ||||||||
| Address2: | |||||||||
| City: | SALINA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 674017601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858273551 | ||||||||
| FaxNumber: | 7858273576 | ||||||||
| Practice Location | |||||||||
| Address1: | 2770 S 9TH ST | ||||||||
| Address2: | |||||||||
| City: | SALINA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 674017601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858273551 | ||||||||
| FaxNumber: | 7858273576 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2013 | ||||||||
| LastUpdateDate: | 04/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 76109 | KS | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363LF0000X | 76109 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 003719320 | 01 | MEDICARE | OTHER |