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Individual
MR. KRISTOPHER WYATT DECKER
Active
Individual
MR. KRISTOPHER WYATT DECKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-08659
NC
363A00000X
Physician Assistant
3643-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0010-08659
STATE OF NC
NC
01
—
085-005532
STATE OF IL
IL
01
—
3643-23
STATE OF WI
WI
Enumeration date
11/30/2015
Last updated
03/07/2023
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