Active NPI
Amanda Sue Decker, PHARMD
- Pharmacist
- Nixa, MO
National Provider Identifier
1396756359
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 2001023388
- Practice address
- 1102 N Massey Blvd
Nixa, MO 65714-7607 - Phone
- (417) 724-0798
- NPI assigned
- Aug 11, 2006
- Last updated
- Sep 12, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PD09323 | AR | |
| Pharmacist | 183500000X | 2001023388 | MO | Primary |
Addresses
Primary practice location
1102 N Massey Blvd
Nixa, MO 65714-7607
Mailing address
180 Meadowbrook
Walnut Shade, MO 65771-9332
Phone (417) 294-4085
Other practice location 1
127 N Main St
Harrison, AR 72601-4227
Phone (870) 741-6511
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2001023388 | Other | MO | MO LISC |
| 35914908 | Medicaid | MO | |
| PD09323 | Other | AR | AR LISC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PD09323 | AR | MD | Pharmacist |
| 2001023388 | MO | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1726099200000",
"number": "1396756359",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "180 MEADOWBROOK",
"city": "WALNUT SHADE",
"state": "MO",
"postal_code": "657719332",
"telephone_number": "417-294-4085"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1102 N MASSEY BLVD",
"city": "NIXA",
"state": "MO",
"postal_code": "657147607",
"telephone_number": "417-724-0798"
}
],
"practiceLocations": [
{
"address_1": "127 N Main St",
"address_purpose": "LOCATION",
"city": "Harrison",
"state": "AR",
"postal_code": "726014227",
"country_code": "US",
"telephone_number": "870-741-6511",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DECKER",
"first_name": "AMANDA",
"middle_name": "SUE",
"name_prefix": "Mrs.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-11",
"last_updated": "2024-09-12",
"certification_date": "2024-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AR",
"license": "PD09323",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "2001023388",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MO LISC",
"identifier": "2001023388",
"state": "MO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "35914908",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AR LISC",
"identifier": "PD09323",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Nixa, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.