MR. KRISTOPHER WYATT DECKER (NPI# 1154795227) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154795227 |
| Entity Type | Individual |
| Full Name | MR. KRISTOPHER WYATT DECKER |
| Credential | PA-C |
| Practice Address |
222 Ashville Ave Ste 10 Cary NC 27518-6130 |
| Practice Telephone | 9198591136 |
| Mailing Telephone | 1985911369 |
| Enumeration Date | 2015-11-30 |
| Last Update Date | 2019-11-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 0010-08659 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363A00000X | Physician Assistant | 3643-23 | WI | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | STATE OF NC | 0010-08659 | 01 |
| IL | STATE OF IL | 085-005532 | 01 |
| DEA - NC | MD5346312 | 01 | |
| DEA - WI | MD3729362 | 01 | |
| WI | STATE OF WI | 3643-23 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2930 Forestville Rd, Raleigh, NC 276168774 | 9192356550 | |
| 231 N Judd Pkwy Ne, Fuquay Varina, NC 275262694 | 9192356410 | |
| 811 Us 70 Hwy W, Garner, NC 275292541 | 9192356565 | |
| 2406 Blue Ridge Rd Ste 190, Raleigh, NC 276076680 | 9197894322 |
| Street Address |
222 ASHVILLE AVE STE 10 |
| City | CARY |
| State | NC |
| Zip Code | 27518-6130 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811304678 | Wake Specialty Physicians, LLC | Durable Medical Equipment & Medical Supplies | 222 Ashville Ave Ste 10, Cary, NC 27518-6130 | 2014-07-14 |
| 1184289159 | Wakemed Specialists Group, LLC | Clinic/Center | 222 Ashville Ave Ste 10, Cary, NC 27518-6130 | 2019-05-06 |
| 1790293215 | Renee Brack | Registered Nurse | 222 Ashville Ave Ste 10, Cary, NC 27518-6130 | 2018-01-18 |
| 1013363514 | Lucia Fernanda Reyes | Family Medicine | 222 Ashville Ave Ste 10, Cary, NC 27518-6130 | 2016-05-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932730801 | Fuller & Associates Iv, Pllc | Dentist | 3420 Ten-ten Road, Suite 310, Cary, NC 27518 | 2020-01-30 |
| 1649761602 | Uday N Reebye, Md. Dmd, Pa | Dentist | 431 Keisler Dr Ste 101, Cary, NC 27518 | 2018-05-25 |
| 1164912093 | Cary Dental Rejuvenation | Dentist | 155 Parkway Office Court, Suite 104, Cary, NC 27518 | 2018-05-16 |
| 1104337021 | Kaylah Mckinley Black | Nurse Practitioner | 530 New Waverly Pl Ste 301, Cary, NC 27518 | 2017-10-18 |
| 1013442961 | Amber Pinsky | Occupational Therapist | 5310 Woodfield Lake Road, Cary, NC 27518 | 2017-04-28 |
| 1750733564 | Maureen Lyons Reardon | Psychologist | 2500 Regency Parkway, Cary, NC 27518 | 2016-07-05 |
| 1730539651 | Anna Liakh | Dentist | 8204 Tryon Woods Dr, Cary, NC 27518 | 2016-06-21 |
| 1609236173 | Matthew John Myschisin II | Chiropractor | 4312 Farm Brook Dr, Cary, NC 27518 | 2016-02-26 |
| 1003299405 | Amanda Lee Morris | Social Worker | 531 Keisler Dr Ste 104, Cary, NC 27518 | 2015-07-02 |
| 1053791343 | Duke University Affiliated Physicians | Family Medicine | 530 Waverly Place, Suite 101, Cary, NC 27518 | 2015-06-02 |
| Find all providers in zip 27518 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003446139 | Monika Kumari | Physician Assistant | 2305 Lakeside View Ct, Cary, NC 27513-8486 | 2020-01-16 |
| 1740843234 | Lindsay Hildreth | Physician Assistant | 107 Silverrock Ct, Cary, NC 27513-2862 | 2019-04-19 |
| 1619480597 | Alexandra Mclaws | Physician Assistant | 100 Parkway Office Ct Ste 106, Cary, NC 27518-7438 | 2017-11-14 |
| 1568980282 | Lindsay Allison Hoffman | Physician Assistant | 100 Ridge View Dr Ste 105, Cary, NC 27511-5589 | 2017-09-01 |
| 1639600463 | Brian J O'neill | Physician Assistant | 900 Maroubra Loop Apt 8203, Cary, NC 27513-8850 | 2017-03-23 |
| 1760885149 | Danielle Marie Sawrey-kubicek | Physician Assistant | 7560 Carpenter Fire Station Rd Ste 305, Cary, NC 27519-9637 | 2014-09-30 |
| 1619283066 | Jamie E. Herzig | Physician Assistant | 204 Davis Grove Cir, Suite 103, Cary, NC 27519-2580 | 2010-08-24 |
| 1538393640 | Himanshu Ramesh Kenjale | Physician Assistant | 115 Kildaire Park Dr Ste 205, Cary, NC 27518-8144 | 2009-05-05 |
| 1295923662 | Urgent Care of Cary PC | Physician Assistant | 3420 Ten-ten Rd, Suite 318, Cary, NC 27518 | 2007-10-10 |
| 1982891818 | Leigh Ellen Freeman | Physician Assistant | 105 Ridgeview Dr, Cary, NC 27511-9998 | 2007-09-25 |
| Find all providers in CARY | ||||
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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.