DR. KENNETH A DECOURSEY (NPI# 1356473797) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356473797 |
| Entity Type | Individual |
| Full Name | DR. KENNETH A DECOURSEY |
| Credential | M.D. |
| Practice Address |
1723 Broadway, Suite 120 Cape Girardeau MO 63701 |
| Mailing Address |
5311 Lexington St Jackson MO 63755-3825 |
| Practice Telephone | 5733347194 |
| Practice Fax Number | 5733344937 |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2007-07-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 102354 | MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| UNITED HEALTHCARE | 0106771 | 01 | |
| RAILROAD MEDICARE ID | DA3724 | 01 | |
| HEALTHLINK | 649138 | 01 | |
| MO | BLUE CROSS BLUE SHIELD | 131268 | 01 |
| MO | BLUE CROSS BLUE SHIELD | 180360 | 01 |
| RAILROAD MEDICARE ID | P00056880 | 01 |
| Street Address |
1723 BROADWAY, SUITE 120 |
| City | CAPE GIRARDEAU |
| State | MO |
| Zip Code | 63701 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336748110 | Westbrook Dialysis, LLC | Clinic/Center | 140 West Drive, Cape Girardeau, MO 63701 | 2020-10-22 |
| 1972079580 | Savannah Laine Menard | Behavior Technician | 20 S. Sprigg St, Cape Girardeau, MO 63701 | 2018-10-22 |
| 1932690377 | Broadway Specialty, LLC | Pharmacy | 706 Broadway St, Cape Girardeau, MO 63701 | 2018-05-22 |
| 1356864649 | Terri L. Mccord | Pharmacist | 4170 Connor Dr, Cape Girardeau, MO 63701 | 2017-07-19 |
| 1013459312 | Christina Cossou | Nurse Practitioner | 2116 Megan Dr Ste 102, Cape Girardeau, MO 63701 | 2016-11-17 |
| 1124573365 | Ashley Sullivan | Massage Therapist | 3041 Melrose Ave, Cape Girardeau, MO 63701 | 2016-08-17 |
| 1225432172 | Axpm - Merkley, LLC | Dentist | 2116 Megan Dr., Suite 101, Cape Girardeau, MO 63701 | 2014-10-21 |
| 1639573397 | Marian Perez Hurt | Physical Therapist | 2001 N. Kingshighway, Fountainbleau Lodge, Cape Girardeau, MO 63701 | 2014-10-09 |
| 1891194213 | Deanna Abner | Case Manager/Care Coordinator | 20 South Sprigg, Cape Girardeau, MO 63701 | 2014-08-21 |
| 1831506880 | Kwadwo O Britwum | Behavioral Analyst | Morningstar Behavioral Associates, 338 W. Broadway Suite 301, Cape Girardeau, MO 63701 | 2014-07-22 |
| Find all providers in zip 63701 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013542828 | Johns Healthcare Services LLC | Family Medicine | 2001 Independence St Ste A, Cape Girardeau, MO 63703-5805 | 2020-03-12 |
| 1326503376 | Ebo Md LLC | Family Medicine | 1417 N Mount Auburn Rd Ste A, Cape Girardeau, MO 63701-2171 | 2019-02-04 |
| 1780943753 | Jessica Leanne Cox | Family Medicine | 817 S Mount Auburn Rd # 100, Cape Girardeau, MO 63703-6383 | 2012-05-11 |
| 1306133129 | Andrew J Lawrence | Family Medicine | 1723 Broadway St Ste 315, Cape Girardeau, MO 63701-4556 | 2011-06-30 |
| 1477867844 | Drx - East Missouri Providers, P.C. | Family Medicine | 465 S Mount Auburn Road, Suite 103, Cape Girardeau, MO 63703 | 2010-07-28 |
| 1346564879 | Richard William Tobey | Family Medicine | 3250 Gordonville Rd Ste 301, Cape Girardeau, MO 63703 | 2010-03-26 |
| 1679766406 | Byron Cornelius Glenn | Family Medicine | 1353 N Mount Auburn Rd, Suite B, Cape Girardeau, MO 63701-1723 | 2007-08-24 |
| 1225171804 | Charity Beth Sandvos | Family Medicine | 817 S Mount Auburn Rd Ste 100, Cape Girardeau, MO 63703-6383 | 2007-02-14 |
| 1497765994 | Charles J. Lastrapes, D.o., LLC | Family Medicine | 937 Broadway St, Suite 203, Cape Girardeau, MO 63701-5493 | 2006-08-08 |
| 1114973161 | James E Palen | Family Medicine | 3129 Blattner Dr, Cape Girardeau, MO 63703-6364 | 2006-05-25 |
| Find all providers in CAPE GIRARDEAU | ||||
| City | CAPE GIRARDEAU |
| Zip Code | 63701 |
Please comment or provide details below to improve the information on DR. KENNETH A DECOURSEY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.