Provider Demographics
NPI:1841612066
Name:DEPTA, AMY HART (FNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:HART
Last Name:DEPTA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 SGT PRENTISS DR
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4726
Mailing Address - Country:US
Mailing Address - Phone:731-697-9118
Mailing Address - Fax:601-443-2722
Practice Address - Street 1:4004 CARTER ST
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:LA
Practice Address - Zip Code:71373-3013
Practice Address - Country:US
Practice Address - Phone:731-697-9118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000121976163W00000X
TNAPN0000018224363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse