Healthcare Provider Details

I. General information

NPI: 1942054960
Provider Name (Legal Business Name): MARISSA-ASHLEY KISS MS, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 N 21ST ST
NEWARK OH
43055-2921
US

IV. Provider business mailing address

955 N 21ST ST
NEWARK OH
43055-2921
US

V. Phone/Fax

Practice location:
  • Phone: 614-491-8137
  • Fax:
Mailing address:
  • Phone: 614-491-8137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN.473550
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0036959
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: