Lisa Deptula, PA, MD is a
Student In An Organized Health Care Education/training Program based in Southaven, Mississippi. Lisa Deptula is licensed to practice in * (Not Available) (license number ) and her current practice location is
7601 Southcrest Pkwy, Southaven, Mississippi. She can be reached at her office (for appointments etc.) via phone at
(662) 772-3607.
NPI number for Lisa Deptula is 1184052508 and her current mailing address is 7601 Southcrest Pkwy, Southaven, Mississippi. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1184052508.
Provider's Profile
| Full Name | Lisa Deptula |
|---|
| Gender | Female |
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| Speciality | Student In An Organized Health Care Education/training Program |
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| Location | 7601 Southcrest Pkwy, Southaven, Mississippi |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1184052508
- Provider Enumeration Date: 10/22/2013
- Last Update Date: 04/22/2025
Medical Identifiers
Medical identifiers for Lisa Deptula such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1184052508 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 363A00000X | Physician Assistant | PA54017 (California) | Secondary |
| 363A00000X | Physician Assistant | 5601006710 (Michigan) | Secondary |
| 390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Lisa Deptula is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Lisa Deptula, PA, MD
7601 Southcrest Pkwy,
Southaven, MS 38671-4739
Ph: () - | Lisa Deptula, PA, MD
7601 Southcrest Pkwy,
Southaven, MS 38671-4739
Ph: (662) 772-3607 |
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