Provider Demographics
NPI:1063972164
Name:DECKER, KATHRYN TULLEY (MD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:TULLEY
Last Name:DECKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 BILTMORE AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4601
Mailing Address - Country:US
Mailing Address - Phone:828-771-4229
Mailing Address - Fax:
Practice Address - Street 1:1201 PATTON AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-2707
Practice Address - Country:US
Practice Address - Phone:828-252-8759
Practice Address - Fax:828-255-8028
Is Sole Proprietor?:No
Enumeration Date:2019-03-23
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2022-00367208D00000X, 208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program