Provider Demographics
NPI:1619913019
Name:STORY, MARCI MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:MARCI
Middle Name:MARIE
Last Name:STORY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARCI
Other - Middle Name:MARIE
Other - Last Name:STORY-KRIEGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:5313 SR 64
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208
Mailing Address - Country:US
Mailing Address - Phone:833-362-4853
Mailing Address - Fax:941-277-9933
Practice Address - Street 1:5313 SR 64
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208
Practice Address - Country:US
Practice Address - Phone:833-362-4853
Practice Address - Fax:941-277-9933
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK72051363LF0000X
FL11012705363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP00297410OtherRAILROAD MEDICARE
OK200089180AMedicaid
OKQ18628Medicare UPIN
OK243531106Medicare PIN