Provider Demographics
NPI:1184803470
Name:DECKER, KIMBERLEE DAWNE (DNP APRN FNP-BC)
Entity type:Individual
Prefix:DR
First Name:KIMBERLEE
Middle Name:DAWNE
Last Name:DECKER
Suffix:
Gender:F
Credentials:DNP APRN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 NE MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-4000
Mailing Address - Country:US
Mailing Address - Phone:406-350-4067
Mailing Address - Fax:406-535-5837
Practice Address - Street 1:611 NE MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-4000
Practice Address - Country:US
Practice Address - Phone:406-350-4067
Practice Address - Fax:406-535-5837
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-RN-LIC49384363LF0000X
MTNUR-APRN-LIC-100952363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1184803470Medicaid