Healthcare Provider Details

I. General information

NPI: 1720843998
Provider Name (Legal Business Name): DEEPA PUN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2024
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 MEDICAL GROUP 527 TUSKEGEE AIRMEN AVE. SHEPPARD AFB
APO AA
76311
US

IV. Provider business mailing address

82 MEDICAL GROUP 527 TUSKEGEE AIRMEN AVE. SHEPPARD AFB
APO AA
76311
US

V. Phone/Fax

Practice location:
  • Phone: 940-676-1847
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1153013
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: