Active NPI
Melissa Deckard
- Specialist
- Pine River, MN
National Provider Identifier
1679753263
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- OTT200024
- Practice address
- 530 2ND St SW
Pine River, MN 56474-4019 - Phone
- (601) 669-0848
- NPI assigned
- Nov 12, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Specialist | 174400000X | OTT200024 | LA | Primary |
| Specialist | 174400000X | OT1872 | MS |
Addresses
Primary practice location
530 2ND St SW
Pine River, MN 56474-4019
Mailing address
530 2ND St SW
Pine River, MN 56474-4019
Phone (601) 669-0848
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OTT200024 | LA | MD | Specialist |
| OT1872 | MS | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1194825600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1194825600000",
"number": "1679753263",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "530 2ND ST SW",
"city": "PINE RIVER",
"state": "MN",
"postal_code": "564744019",
"telephone_number": "601-669-0848"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "530 2ND ST SW",
"city": "PINE RIVER",
"state": "MN",
"postal_code": "564744019",
"telephone_number": "601-669-0848"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DECKARD",
"first_name": "MELISSA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-11-12",
"last_updated": "2007-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "LA",
"license": "OTT200024",
"primary": true
},
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "MS",
"license": "OT1872",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pine River, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.