Provider Demographics
NPI:1205481868
Name:YEPEZ, MARISSA MICHELLE
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:MICHELLE
Last Name:YEPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 AVENUE E
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-6561
Mailing Address - Country:US
Mailing Address - Phone:406-281-8700
Mailing Address - Fax:
Practice Address - Street 1:3401 AVENUE E
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6561
Practice Address - Country:US
Practice Address - Phone:406-281-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-09
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142499363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT204117OtherMONTANA BOARD OF NURSING
TXAP142499OtherTEXAS BOARD OF NURSING-FNP LICENSE