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General NPI Number Information
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NPI Number | 1962154559
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Entity Type | Individual
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Provider Name | JESSICA C DECKER NP
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Gender | Female
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Dates
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Enumeration Date | 01/25/2022
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Last Update Date | 03/15/2022
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Provider Practice Location Address
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Address Line | 3535 SOUTHERN BLVD
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City | KETTERING
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State | OH
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Zip | 45429-1221
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Country | US
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Telephone | 937-395-8166
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Fax |
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Provider Business Mailing Address
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Address Line | 3131 NEWMARK DR STE 220
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City | MIAMISBURG
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State | OH
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Zip | 45342-5400
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Country | US
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Telephone | 937-438-8910
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN.CNP.0030908
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2021185662
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | RN.361849
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License Number State | OH
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