Provider Demographics
NPI:1427431295
Name:DECANT, KATHY (FNP-C)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:DECANT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 CLARENCE E CHESNUT JR BYPASS
Mailing Address - Street 2:STE A
Mailing Address - City:CENTRE
Mailing Address - State:AL
Mailing Address - Zip Code:35960-2812
Mailing Address - Country:US
Mailing Address - Phone:256-266-1544
Mailing Address - Fax:
Practice Address - Street 1:1260 CLARENCE E CHESNUT JR BYPASS
Practice Address - Street 2:STE A
Practice Address - City:CENTRE
Practice Address - State:AL
Practice Address - Zip Code:35960-2812
Practice Address - Country:US
Practice Address - Phone:256-266-1544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11000785363LF0000X
AL1-063700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL177287Medicaid