Provider Demographics
NPI:1174810394
Name:DEPRIEST, PATRICK (PA-C)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:DEPRIEST
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13020 KABRICH CR
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71602
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:AL NAKHLA
Practice Address - Street 2:QURTUBAH
Practice Address - City:RIYADH
Practice Address - State:RIYADH
Practice Address - Zip Code:13244
Practice Address - Country:SA
Practice Address - Phone:999-999-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant