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General NPI Number Information
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NPI Number | 1427873942
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Entity Type | Individual
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Provider Name | MARISSA DECKER FNP
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Gender | Female
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Dates
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Enumeration Date | 11/19/2024
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 1980 SE BLUE PKWY STE 2320
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City | LEES SUMMIT
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State | MO
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Zip | 64063-1102
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Country | US
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Telephone | 816-607-2950
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Fax |
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Provider Business Mailing Address
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Address Line | 6718 W 157TH TER
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City | OVERLAND PARK
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State | KS
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Zip | 66223-3578
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | TMP-162696
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License Number State | KS
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