ROGER L DECKER (NPI# 1689154478) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689154478 |
| Entity Type | Individual |
| Full Name | ROGER L DECKER |
| Credential | AGACNP-BC |
| Practice Address |
55 Physicians Ln Southaven MS 38671-9569 |
| Practice Telephone | 6626552136 |
| Mailing Telephone | 6626552136 |
| Enumeration Date | 2018-08-21 |
| Last Update Date | 2020-09-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LA2100X |
Nurse Practitioner Specialization: Acute Care |
902736 | MS | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LA2100X |
Nurse Practitioner Specialization: Acute Care |
24489 | TN | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
55 PHYSICIANS LN |
| City | SOUTHAVEN |
| State | MS |
| Zip Code | 38671-9569 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265409064 | Winston Craig Clark | Neurological Surgery | 55 Physicians Ln, Suite 1, Southaven, MS 38671-9569 | 2006-03-01 |
| 1174171441 | Modern Vascular of Southaven, LLC | Radiologic Technologist | 55 Physicians Ln, Southaven, MS 38671-9569 | 2019-08-29 |
| 1326149956 | The Neurosurgical Center | Neurological Surgery | 55 Physicians Ln, Suite 1, Southaven, MS 38671-9569 | 2006-09-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285196196 | Emma Tinsley-bowles Long | Social Worker | 8786 Northcreek Blvd, Bldg 8 Apt 3, Southaven, MS 38671 | 2019-04-01 |
| 1851847586 | Tiffany Lashea Jones | Adult Companion | 8755 Millbranch Road, Southaven, MS 38671 | 2016-09-01 |
| 1538526140 | Desoto Pediatric Extended Care LLC | Skilled Nursing Facility | 750 Stateline Road East, Southhaven, MS 38671 | 2016-01-27 |
| 1073983052 | Tara Burt | Physical Therapist | 7900 Airways Blvd. Building A, Suite 2, Southaven, MS 38671 | 2015-10-02 |
| 1295160463 | Ideal Community Care,llc | In Home Supportive Care | 8869 Centre Str #3, Southaven, MS 38671 | 2013-09-06 |
| 1578995692 | Gregory Charles Eakins Jr. | Optometrist | 338 Goodman Rd West, Southaven, MS 38671 | 2013-07-31 |
| 1295173169 | Erica R. Martin | Social Worker | 975 Swinnea Rdg Ste 3, Southaven, MS 38671 | 2013-06-12 |
| 1386918431 | Freds Stores of Tennessee Inc | Pharmacy | 710 Church Road, Southaven, MS 38671 | 2012-03-06 |
| 1740565613 | Mary Jeanette Scruggs | Pharmacist | 1011 Goodman Rd, Southaven, MS 38671 | 2011-10-11 |
| 1184919268 | First Pharmacy Services 5 | Pharmacy | 5185a Getwell Rd, Southaven, MS 38671 | 2011-06-16 |
| Find all providers in zip 38671 | ||||
| Taxonomy Code | 363LA2100X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Acute Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245871847 | Tammy Q Reed | Nurse Practitioner | 7601 Southcrest Pkwy, Southaven, MS 38671-4739 | 2019-10-04 |
| 1609430842 | William Taylor Hardy | Nurse Practitioner | 401 Southcrest Cir Ste 201, Southaven, MS 38671 | 2019-04-23 |
| 1871078436 | Catherine R Stepter | Nurse Practitioner | 7601 Southcrest Pkwy, Southaven, MS 38671-4739 | 2018-09-30 |
| 1427599067 | Sherrita Rodgers-walton | Nurse Practitioner | 7601 Southcrest Pkwy, Southaven, MS 38671-4739 | 2017-03-15 |
| 1811942170 | Susan M Tolley | Nurse Practitioner | 7601 Southcrest Pkwy, Southaven, MS 38671-4739 | 2006-05-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306450358 | Sara Leanne Davis | Nurse Practitioner | 230 Possum Ridge Rd, Hollandale, MS 38748-3755 | 2020-09-06 |
| 1598385130 | Christy Busby | Nurse Practitioner | 128 Warren St, Pontotoc, MS 38863-1519 | 2020-04-23 |
| 1104459742 | Amanda Paige Michael | Nurse Practitioner | 200 Quail Run, Booneville, MS 38829-9001 | 2020-02-21 |
| 1891328340 | U Matter LLC | Nurse Practitioner | 2440 N Hills St Ste 126, Meridian, MS 39305-2634 | 2020-02-12 |
| 1255978367 | Tanya Haley Mcgee | Nurse Practitioner | 229 Old Yorkville Rd S, Columbus, MS 39702-8440 | 2019-12-08 |
| 1447893888 | Spectrum The Other Clinic | Nurse Practitioner | 2910 Magnolia Pl, Hattiesburg, MS 39402-2428 | 2019-10-17 |
| 1053962068 | Lauren Lanier Guthrie | Nurse Practitioner | 102 Friars Cv, Clinton, MS 39056-3411 | 2019-09-23 |
| 1588212229 | David Buckheister | Nurse Practitioner | 612 Liz Cir, Gulfport, MS 39503-3712 | 2019-08-27 |
| 1821583196 | Amanda Houston Trent | Nurse Practitioner | 4381 S Eason Blvd Ste 203, Tupelo, MS 38801-6557 | 2018-06-28 |
| 1093224446 | Jennifer Hurley | Nurse Practitioner | 2809n Denny Ave, Pascagoula, MS 39581-5301 | 2017-09-28 |
| Find all providers with the same taxonomy | ||||
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| 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.