Provider Demographics
NPI:1366734394
Name:DECKER, KATHRYN C (DPM)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:C
Last Name:DECKER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:KATHRYN
Other - Middle Name:C
Other - Last Name:JETTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:9980 S 300 W STE 310
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-3654
Mailing Address - Country:US
Mailing Address - Phone:801-253-6886
Mailing Address - Fax:385-900-5928
Practice Address - Street 1:3130 S HIGHLAND DR STE B4
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-3095
Practice Address - Country:US
Practice Address - Phone:801-253-6886
Practice Address - Fax:801-253-6888
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10921738-0501213E00000X, 213ER0200X, 213ES0000X, 213ES0103X, 213ES0131X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery