Healthcare Provider Details

I. General information

NPI: 1144706003
Provider Name (Legal Business Name): MARISSA KUO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2018
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 MEDICAL CENTER DR
NASHVILLE TN
37232-0004
US

IV. Provider business mailing address

1161 21ST AVE S CCC-4322 MCN
NASHVILLE TN
37232
US

V. Phone/Fax

Practice location:
  • Phone: 615-343-6642
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: