Individual
ROGER L DECKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AGACNP-BC
Contact information
Practice address
55 PHYSICIANS LN, SOUTHAVEN, MS 38671-9569
(662) 655-2136
Mailing address
55 PHYSICIANS LN, SOUTHAVEN, MS 38671-9569
(662) 655-2136
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
24489
TN
363LA2100X
Acute Care Nurse Practitioner
Primary
902736
MS
Other
Enumeration date
08/21/2018
Last updated
09/01/2020
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