Kenneth a Decoursey, MD PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

KENNETH A DECOURSEY, MD PC

Practice address

1723 Broadway St
Suite 120
Cape Girardeau, MO 63701-4505

Phone

(573) 334-7194

Fax

(573) 334-4937

NPI assigned

May 5, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kenneth A Decoursey, M.D.

Title

President

Phone

(573) 334-7194

Specialties & licenses 1

Addresses

Other identifiers 4

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1144278607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5311 LEXINGTON ST",
            "city": "JACKSON",
            "state": "MO",
            "postal_code": "637553825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1723 BROADWAY ST",
            "address_2": "SUITE 120",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637014505",
            "telephone_number": "573-334-7194",
            "fax_number": "573-334-4937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNETH A DECOURSEY, MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DECOURSEY",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "573-334-7194",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "131268",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "180360",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "0106771",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "649138",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Arielle Elizabeth Kelly, PMHNP-BC
• Carrie Ann Kennedy
• Jacquelyn Malia Kennedy
• Olivia Ann Kennedy, DO
• Patrick B Kennedy, PTA
• Cody Dylan Kern
• Jon-Erik W Kern, PTA
• Scott Thomas Kernan
• Deborah Lucille Kerr, PH.D.
• Melissa Rene Kerr, PHARM. D.

• Family Medicine Physician in Cape Girardeau, MO
• Providers in Cape Girardeau, MO by specialty
• Family Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.