Provider Demographics
NPI:1083867444
Name:DECKER, KATHLEEN RENE (BSN,RN)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:RENE
Last Name:DECKER
Suffix:
Gender:F
Credentials:BSN,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 52
Mailing Address - Street 2:
Mailing Address - City:STIGLER
Mailing Address - State:OK
Mailing Address - Zip Code:74462-0052
Mailing Address - Country:US
Mailing Address - Phone:918-443-0200
Mailing Address - Fax:918-552-9185
Practice Address - Street 1:1407 E MAIN ST UNIT B
Practice Address - Street 2:
Practice Address - City:STIGLER
Practice Address - State:OK
Practice Address - Zip Code:74462-2910
Practice Address - Country:US
Practice Address - Phone:918-443-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR222251363LF0000X
OK210675363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily