Provider Demographics
NPI:1467863191
Name:DEPP, CALEB ANDREW (CRNA)
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:ANDREW
Last Name:DEPP
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:415 N CENTER ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-5057
Mailing Address - Country:US
Mailing Address - Phone:828-327-8105
Mailing Address - Fax:828-327-4245
Practice Address - Street 1:415 N CENTER ST
Practice Address - Street 2:SUITE 201
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-5057
Practice Address - Country:US
Practice Address - Phone:828-327-8105
Practice Address - Fax:828-327-4245
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC202234367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ47206BMedicaid