Healthcare Provider Details

I. General information

NPI: 1710689344
Provider Name (Legal Business Name): KELSEY DECKER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 11TH ST
CHARLES CITY IA
50616-3468
US

IV. Provider business mailing address

800 11TH ST
CHARLES CITY IA
50616-3468
US

V. Phone/Fax

Practice location:
  • Phone: 641-228-6830
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO-55828
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: