MEDICARE: ALYSSA DANIELLE MARSO FNP, AGNP, BMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	2019040441	MO
2	363LG0600X	Gerontology Nurse Practitioner	2019001529	MO
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	G173571	IA
4	363LF0000X	Family Nurse Practitioner	2019040442	MO

General Provider Information

NPI Number	:	1023610318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA DANIELLE MARSO FNP, AGNP, BMHNP

Provider Business Mailing Address
First Line	:	1400 FORUM BLVD
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-1938
Country	:	US
Telephone Number	:	573-200-6024
Fax Number	:	573-224-1862

Provider Business Practice Location Address
First Line	:	1400 FORUM BLVD STE 7A
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-1997
Country	:	US
Telephone Number	:	573-200-6024
Fax Number	:	573-224-1862

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2020
Last Update Date	:	03/09/2026

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