MEDICARE: MARISSA ANN BYRNE DNP, PMHNP-BC

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	163W00000X	Registered Nurse	R46167	ND
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R46167	ND

General Provider Information

NPI Number	:	1063292134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA ANN BYRNE DNP, PMHNP-BC

Provider Business Mailing Address
First Line	:	3788 55TH AVE S STE 205
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58104-5588
Country	:	US
Telephone Number	:	701-205-4847
Fax Number	:	701-540-0441

Provider Business Practice Location Address
First Line	:	3788 55TH AVE S STE 205
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58104-5588
Country	:	US
Telephone Number	:	701-205-4847
Fax Number	:	701-540-0441

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

Provider Enumeration Date	:	10/04/2023
Last Update Date	:	01/20/2026

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