Provider Demographics
NPI:1467121061
Name:DECAMP, STEPHANY (PA)
Entity type:Individual
Prefix:
First Name:STEPHANY
Middle Name:
Last Name:DECAMP
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3178 CASPER ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1071
Mailing Address - Country:US
Mailing Address - Phone:269-999-6432
Mailing Address - Fax:
Practice Address - Street 1:7751 BYRON CENTER AVE SW STE C
Practice Address - Street 2:
Practice Address - City:BYRON CENTER
Practice Address - State:MI
Practice Address - Zip Code:49315-8001
Practice Address - Country:US
Practice Address - Phone:616-267-7668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2025-09-08
Deactivation Date:2025-05-16
Deactivation Code:
Reactivation Date:2025-09-08
Provider Licenses
StateLicense IDTaxonomies
MI5601013344APP25363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant