Provider Demographics
NPI:1427381706
Name:DECKER, EMILY J (PA-C)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:J
Last Name:DECKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:J
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:222 S KANSAS ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:KS
Mailing Address - Zip Code:67665-3000
Mailing Address - Country:US
Mailing Address - Phone:785-483-3333
Mailing Address - Fax:785-483-7631
Practice Address - Street 1:222 S KANSAS ST
Practice Address - Street 2:
Practice Address - City:RUSSELL
Practice Address - State:KS
Practice Address - Zip Code:67665-3000
Practice Address - Country:US
Practice Address - Phone:785-483-3333
Practice Address - Fax:785-483-7631
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01329363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200269400CMedicaid
KS111215OtherBCBS OF KANSAS
KS111215OtherBCBS OF KANSAS