MEDICARE: TALLAN DEPRIEST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	8722	AZ
2	390200000X	Student in an Organized Health Care Education/Training Program
3	208D00000X	General Practice Physician	8722	AZ

General Provider Information

NPI Number	:	1548794399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TALLAN DEPRIEST

Provider Business Mailing Address
First Line	:	1825 E SOUTHERN AVE # 35
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-5814
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3550 E PINCHOT AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-7434
Country	:	US
Telephone Number	:	602-957-4000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2017
Last Update Date	:	01/21/2026

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Directions to “ TALLAN DEPRIEST ” Practice Location

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