Healthcare Provider Details

I. General information

NPI: 1487285946
Provider Name (Legal Business Name): MARISSA RENEE KEHRWALD MSN-C, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 N JESSE JAMES RD
EXCELSIOR SPRINGS MO
64024-1120
US

IV. Provider business mailing address

1345 N JESSE JAMES RD
EXCELSIOR SPRINGS MO
64024-1120
US

V. Phone/Fax

Practice location:
  • Phone: 816-630-9411
  • Fax: 855-642-2047
Mailing address:
  • Phone: 816-630-9411
  • Fax: 855-642-2047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2020003620
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2020003620
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: