Provider Demographics
NPI:1407573744
Name:DECKER, CHELSEY JO (RN)
Entity Type:Individual
Prefix:MRS
First Name:CHELSEY
Middle Name:JO
Last Name:DECKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CHELSEY
Other - Middle Name:JO
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13225 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5480
Mailing Address - Country:US
Mailing Address - Phone:317-715-4863
Mailing Address - Fax:317-795-2047
Practice Address - Street 1:13225 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5480
Practice Address - Country:US
Practice Address - Phone:317-228-7000
Practice Address - Fax:317-795-2047
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28207320A163W00000X
IN71013317A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN28207320AOtherRN LICENSE
IN71013317AOtherNP LICENSE