Provider Demographics
NPI:1528514346
Name:DEPRIEST, LEEANN (NP-C)
Entity type:Individual
Prefix:
First Name:LEEANN
Middle Name:
Last Name:DEPRIEST
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 688
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38025-0688
Mailing Address - Country:US
Mailing Address - Phone:731-288-0911
Mailing Address - Fax:731-288-0065
Practice Address - Street 1:1716 PARR AVE
Practice Address - Street 2:SUITE D
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-2074
Practice Address - Country:US
Practice Address - Phone:731-288-0911
Practice Address - Fax:731-288-0065
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21355363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily