DR. KATHERINE ANNE DECOLIBUS (NPI# 1124037379) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124037379 |
| Entity Type | Individual |
| Full Name | DR. KATHERINE ANNE DECOLIBUS |
| Credential | DDS |
| Practice Address |
10825 Old Highway 64 Bolivar TN 38008-3599 |
| Mailing Address |
4132 Poplar Ave Memphis TN 38117-3618 |
| Practice Telephone | 7316585291 |
| Practice Fax Number | 7316586536 |
| Mailing Telephone | 9016800377 |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2009-08-06 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
7389 | TN | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | 16170 | 05 |
| Street Address |
10825 OLD HIGHWAY 64 |
| City | BOLIVAR |
| State | TN |
| Zip Code | 38008-3599 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831716257 | Yulando A Taylor | Registered Nurse | 10825 Old Highway 64, Bolivar, TN 38008-3599 | 2020-07-01 |
| 1225669500 | Meghan Curtise Lambert-agnew | Registered Nurse | 10825 Old Highway 64, Bolivar, TN 38008-3599 | 2020-01-27 |
| 1124402698 | Mary Ross | Registered Nurse | 10825 Old Highway 64, Bolivar, TN 38008-3599 | 2015-07-15 |
| 1467843995 | Mary Young | Registered Nurse | 10825 Old Highway 64, Bolivar, TN 38008-3599 | 2015-02-05 |
| 1730590266 | April Smtih | Registered Nurse | 10825 Old Highway 64, Bolivar, TN 38008-3599 | 2014-05-19 |
| 1730590373 | Danielle Mott | Registered Nurse | 10825 Old Highway 64, Bolivar, TN 38008-3599 | 2014-05-16 |
| 1982014593 | Nancy Utley | Registered Nurse | 10825 Old Highway 64, Bolivar, TN 38008-3599 | 2014-05-05 |
| 1477999795 | Janet M Young | Registered Nurse | 10825 Old Highway 64, Bolivar, TN 38008-3599 | 2013-05-14 |
| 1558637678 | Beth Anne Cossar | Registered Nurse | 10825 Old Highway 64, Bolivar, TN 38008-3599 | 2012-03-23 |
| 1770879512 | Jessica Stephenson | Registered Nurse | 10825 Old Highway 64, Bolivar, TN 38008-3599 | 2011-06-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720639172 | Shanna Shackelford | Nurse Practitioner | 11100 Old Hwy 64 W, Bolivar, TN 38008 | 2019-09-26 |
| 1598326233 | Holly Brooke Shourd | Family Medicine | 1359 W Market St., Bolivar, TN 38008 | 2019-06-24 |
| 1992299234 | Angela Dawn Haynes | Registered Nurse | 10825 Hwy 64w, Bolivar, TN 38008 | 2018-06-20 |
| 1326595919 | Ashley Evon Jowers | Nurse Practitioner | 11100 Old Hwy 64 West, Bolivar, TN 38008 | 2016-09-01 |
| 1942458344 | Anita Pearl Johnson | Physical Therapy Assistant | 700 Knuckolls Ave, Bolivar, TN 38008 | 2008-08-28 |
| 1841340007 | State of Tennessee | Public Health or Welfare | 10825 Old Hwy 64, Bolivar, TN 38008 | 2007-01-11 |
| 1164479721 | Betty Ragon Lenoir | Physical Therapist | 789 Tennessee St, Bolivar, TN 38008 | 2006-05-28 |
| 1689623050 | County of Hardeman | Ambulance | 735 Naylor St, Bolivar, TN 38008 | 2006-05-10 |
| 1841287109 | Michiel Brent Rudder | Family Medicine | 622 West Market Street, Bolivar, TN 38008 | 2005-10-03 |
| 1982606497 | Richard Mast Reinhard IIi | Pediatrics | 629 Nuckolls Rd, Bolivar, TN 38008 | 2005-08-15 |
| Find all providers in zip 38008 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861795312 | Jump Dental, LLC | Dentist | 1300 N Oakland Ave Ste C, Bolivar, MO 65613-3008 | 2010-12-06 |
| 1881817625 | Thomas Gregory Wilson | Dentist | 105 South Porter Street, Bolivar, TN 38008-1734 | 2007-04-10 |
| 1134253305 | Anita Jo Parks | Dentist | 390 Railroad St Ste D, Bolivar, TN 38008-2661 | 2007-03-16 |
| 1548373897 | Paul Andres Gonzales | Dentist | 2392 S Springfield Ave, Bolivar, MO 65613-9124 | 2006-08-17 |
| 1124284658 | Daniel T. Goodman Dds LLC | Dentist | 305 E Broadway St, Bolivar, MO 65613-1625 | 2008-08-04 |
| 1780869883 | Timothy R Jump | Dentist | 1300 N Oakland Ave, Ste C, Bolivar, MO 65613 | 2008-01-08 |
| 1316145188 | Donald R Jump | Dentist | 1300 N Oakland Ave, Ste C, Bolivar, MO 65613 | 2007-07-03 |
| 1306044177 | Kim S Davison | Dentist | 1300 N Oakland Ave, Ste C, Bolivar, MO 65613 | 2007-07-03 |
| 1982734596 | Smiles R Us Dental Care | Dentist | 407 W Lafayette St, Bolivar, TN 38008-2651 | 2007-03-06 |
| 1073668216 | Dr. Donald R. Jump Dds Inc PC | Dentist | 1300 N Oakland Ave, Ste C, Bolivar, MO 65613 | 2007-01-25 |
| Find all providers in BOLIVAR | ||||
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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.