MEDICARE: MARY JOAN DECKER APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	512508	TX

General Provider Information

NPI Number	:	1295022770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY JOAN DECKER APRN

Provider Business Mailing Address
First Line	:	7432 SEAN DR
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76182-4552
Country	:	US
Telephone Number	:	817-788-0442
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 BOURLAND RD STE D
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76248-3507
Country	:	US
Telephone Number	:	817-864-8824
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2011
Last Update Date	:	06/11/2024

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