Individual
KIMBERLY K DECKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3355 EAGLE PARK DR NE, SUITE 103, GRAND RAPIDS, MI 49525-7004
(616) 942-7400
(616) 942-7405
Mailing address
3264 N EVERGREEN DR NE, GRAND RAPIDS, MI 49525-9746
(616) 363-7339
(616) 363-7339
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601004650
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5601004650
MICHIGAN LICENSE
MI
Enumeration date
05/12/2006
Last updated
05/19/2017
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