Healthcare Provider Details

I. General information

NPI: 1013845205
Provider Name (Legal Business Name): KATHLEEN MARIE DECKER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 N 99TH AVE STE 109
AVONDALE AZ
85323-5327
US

IV. Provider business mailing address

9164 N 97TH AVE
PEORIA AZ
85345-6352
US

V. Phone/Fax

Practice location:
  • Phone: 623-907-1457
  • Fax:
Mailing address:
  • Phone: 973-204-5810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number332930
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: