Provider Demographics
NPI:1487285946
Name:KEHRWALD, MARISSA RENEE (MSN-C, FNP-C)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:RENEE
Last Name:KEHRWALD
Suffix:
Gender:F
Credentials:MSN-C, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 N JESSE JAMES RD
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64024-1120
Mailing Address - Country:US
Mailing Address - Phone:816-630-9411
Mailing Address - Fax:855-642-2047
Practice Address - Street 1:1345 N JESSE JAMES RD
Practice Address - Street 2:
Practice Address - City:EXCELSIOR SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64024-1120
Practice Address - Country:US
Practice Address - Phone:816-630-9411
Practice Address - Fax:855-642-2047
Is Sole Proprietor?:No
Enumeration Date:2020-02-03
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020003620207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1487285946Medicaid