Provider Demographics
NPI:1144691528
Name:KLEFFMAN UNDERWOOD, MARISSA F (ARNP)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:F
Last Name:KLEFFMAN UNDERWOOD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:F
Other - Last Name:KLEFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1204 E FIRE TOWER RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-4196
Practice Address - Country:US
Practice Address - Phone:252-744-1122
Practice Address - Fax:252-744-1133
Is Sole Proprietor?:No
Enumeration Date:2015-10-12
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5008128363LF0000X
NC264412363LF0000X
FLARNP9467370363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
19GSYOtherBCBS OF NC
NC1144691528Medicaid
NCNCR001BOtherMEDICARE