Basic Information
| Provider Information | |||||||||
| NPI: | 1467863191 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEPP | ||||||||
| FirstName: | CALEB | ||||||||
| MiddleName: | ANDREW | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 415 N CENTER ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286015057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283278105 | ||||||||
| FaxNumber: | 8283274245 | ||||||||
| Practice Location | |||||||||
| Address1: | 415 N CENTER ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286015057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283278105 | ||||||||
| FaxNumber: | 8283274245 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2014 | ||||||||
| LastUpdateDate: | 06/23/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 202234 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | Q47206B | 05 | NC | MEDICAID |