Individual provider · Type 1 NPI

Lisa Deptula, PA, MD

Student in an Organized Health Care Education/Training Program · Southaven, MS

NPI number 1184052508 Active

Practice location

7601 Southcrest Pkwy
Southaven, MS 38671-4739

Call (662) 772-3607 Map

Other practice locations

  • 2144 4th St Ste A, San Rafael, CA 94901 · (415) 390-2060
  • 203 Winston Dr, Marshall, MI 49068-8526 · (269) 789-1670

Specialties and licenses

TaxonomyCodeLicense
Physician Assistant 363A00000XPA54017 (CA)
Physician Assistant 363A00000X5601006710 (MI)
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1184052508

Lisa Deptula, PA, MD's National Provider Identifier is 1184052508, issued on Oct 22, 2013. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Southaven, MS. The record was last updated on Apr 22, 2025.