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General NPI Number Information
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NPI Number | 1992453542
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Entity Type | Individual
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Provider Name | MARQUISSA BRENT DNP
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Gender | Female
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Dates
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Enumeration Date | 03/14/2022
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 1500 N WESTWOOD BLVD
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-3318
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Country | US
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Telephone | 573-778-4220
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Fax |
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Provider Business Mailing Address
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Address Line | 2301 S 20TH ST
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City | PARAGOULD
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State | AR
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Zip | 72450-1981
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | F12200856
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License Number State | AL
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