Healthcare Provider Details

I. General information

NPI: 1851732911
Provider Name (Legal Business Name): JAYARAMAKRISHNA DEPA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2013
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 BALL PARK RD
HARLAN KY
40831-1701
US

IV. Provider business mailing address

37 BALL PARK RD
HARLAN KY
40831-1701
US

V. Phone/Fax

Practice location:
  • Phone: 606-573-4520
  • Fax: 606-574-8383
Mailing address:
  • Phone: 606-573-4520
  • Fax: 606-573-6392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number50838
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: