Healthcare Provider Details

I. General information

NPI: 1982088712
Provider Name (Legal Business Name): BETH ANN DECKER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETH ANN PARKER RN

II. Dates (important events)

Enumeration Date: 07/10/2015
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N ILLINOIS ST FL 16
INDIANAPOLIS IN
46204-1904
US

IV. Provider business mailing address

9216 HAWLEY DR
INDIANAPOLIS IN
46216-2251
US

V. Phone/Fax

Practice location:
  • Phone: 859-492-2657
  • Fax:
Mailing address:
  • Phone: 859-492-2657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71010544A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: