MEDICARE: MARISSA ANN DEBOARD APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	4007196	KY

General Provider Information

NPI Number	:	1134999899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA ANN DEBOARD APRN

Provider Business Mailing Address
First Line	:	5000 KY ROUTE 321
Second Line	:
City	:	PRESTONSBURG
State	:	KY
Zip	:	41653-9113
Country	:	US
Telephone Number	:	606-886-7645
Fax Number	:	606-889-6206

Provider Business Practice Location Address
First Line	:	5000 KY ROUTE 321
Second Line	:
City	:	PRESTONSBURG
State	:	KY
Zip	:	41653-9113
Country	:	US
Telephone Number	:	606-886-7545
Fax Number	:	606-889-6206

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2024
Last Update Date	:	01/26/2026

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