Healthcare Provider Details

I. General information

NPI: 1841612066
Provider Name (Legal Business Name): AMY HART DEPTA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2014
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4004 CARTER ST
VIDALIA LA
71373-3013
US

IV. Provider business mailing address

54 SGT PRENTISS DR
NATCHEZ MS
39120-4726
US

V. Phone/Fax

Practice location:
  • Phone: 731-697-9118
  • Fax:
Mailing address:
  • Phone: 731-697-9118
  • Fax: 601-443-2722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000018224
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0000121976
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: