Katelyn Decker, L.AC., M.AC.O.M.

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

150593 Issued in OR

Practice address

130 NW Miller Ave
Gresham, OR 97030-7226

Phone

(503) 568-1646

Fax

(833) 603-1296

NPI assigned

Jan 27, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Antara Acupuncture and Herbal Clinic LLC

  • Acupuncturist
  • Gresham, OR
  • NPI 1356692115
  Authorized official Same address or phone

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

{
    "created_epoch": "1264550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612396800000",
    "number": "1235460494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2627 NE BROADWAY ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972321720",
            "telephone_number": "971-235-1171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 NW MILLER AVE",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970307226",
            "telephone_number": "503-568-1646",
            "fax_number": "833-603-1296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DECKER",
        "first_name": "KATELYN",
        "name_prefix": "Ms.",
        "credential": "L.AC., M.AC.O.M.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-01-27",
        "last_updated": "2021-02-04",
        "certification_date": "2021-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "OR",
            "license": "150593",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500650081",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Acupuncturist in Gresham, OR
• Providers in Gresham, OR by specialty
• Acupuncturist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2021; 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.