Individual
KELLY DIANA DECKARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
2120 N CENTRAL AVE, PHOENIX, AZ 85004-1455
(602) 933-6100
(602) 933-2422
Mailing address
2108 E THOMAS RD STE 130, PHOENIX, AZ 85016-0008
(602) 933-1813
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
274000
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
158847
—
AZ
Enumeration date
10/23/2013
Last updated
06/21/2024
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