Healthcare Provider Details

I. General information

NPI: 1003007741
Provider Name (Legal Business Name): KRISANNA LEE DEPPEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 06/06/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 E TOWN ST STE 116
COLUMBUS OH
43215-4799
US

IV. Provider business mailing address

PO BOX 7527
DUBLIN OH
43017-0727
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-9108
  • Fax: 614-566-8737
Mailing address:
  • Phone: 614-788-5400
  • Fax: 614-788-5500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35088823
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number35.088823
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: