Healthcare Provider Details

I. General information

NPI: 1205158441
Provider Name (Legal Business Name): DEANNA DEPUGH CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2010
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date: 12/19/2018
Reactivation Date: 01/17/2019

III. Provider practice location address

445 N HIGH ST 445 1/2 IS SIDE OFFICE
CHILLICOTHEE OH
45601
US

IV. Provider business mailing address

445 N HIGH ST 445 1/2 IS SIDE OFFICE
CHILLICOTHEE OH
45601
US

V. Phone/Fax

Practice location:
  • Phone: 740-327-0400
  • Fax: 740-327-0500
Mailing address:
  • Phone: 740-327-0400
  • Fax: 740-327-0500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.385441
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.024108
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: