Healthcare Provider Details

I. General information

NPI: 1154168086
Provider Name (Legal Business Name): CHARISE ALICIA MARTI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2024
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14680 W 144TH ST
OLATHE KS
66062-9765
US

IV. Provider business mailing address

14680 W 144TH ST
OLATHE KS
66062-9765
US

V. Phone/Fax

Practice location:
  • Phone: 913-800-0839
  • Fax: 949-810-5428
Mailing address:
  • Phone: 913-800-0839
  • Fax: 949-810-5428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number53-83411-121
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number14-116708-121
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2012023983
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: