Provider Demographics
NPI:1588860548
Name:DEPRIEST, AUNDREA (BS)
Entity Type:Individual
Prefix:
First Name:AUNDREA
Middle Name:
Last Name:DEPRIEST
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:AUNDREA
Other - Middle Name:NICOLE
Other - Last Name:DEPRIEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 9054
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-9054
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3644
Practice Address - Street 1:RR 6 BOX 540
Practice Address - Street 2:
Practice Address - City:GATE CITY
Practice Address - State:VA
Practice Address - Zip Code:24251-9760
Practice Address - Country:US
Practice Address - Phone:276-452-1144
Practice Address - Fax:276-452-1140
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator