Marisa Mae Kelly, RN

Primary specialty

Registered Nurse First AssistantTaxonomy code 163WR0006X

License

168876 Issued in AK

Practice address

425 E Dahlia Ave Ste J
Palmer, AK 99645-6463

Phone

(907) 746-1520

Fax

(907) 746-1521

NPI assigned

Feb 4, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Glacier Surgical Associates, Inc

  • Surgery Physician
  • Palmer, AK
  • NPI 1568861086
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1612396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614038400000",
    "number": "1053903799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 E DAHLIA AVE STE J",
            "city": "PALMER",
            "state": "AK",
            "postal_code": "996456463",
            "telephone_number": "907-746-1520",
            "fax_number": "907-746-1521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 E DAHLIA AVE STE J",
            "city": "PALMER",
            "state": "AK",
            "postal_code": "996456463",
            "telephone_number": "907-746-1520",
            "fax_number": "907-746-1521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "MARISA",
        "middle_name": "MAE",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-04",
        "last_updated": "2021-02-23",
        "certification_date": "2021-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WR0006X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Registered Nurse First Assistant",
            "state": "AK",
            "license": "168876",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cassandra Angela Justice, RN
• Annette Kasprzak, M.D
• Katie Gatica Physical Therapy, LLC
• Laken Keller
• Carla Beth Kelly
• Owen Kelly
• Vaughn William Kelly, FNP
• Heidi Jo Kemble, LMT
• Alice Raven Kenneally, PA-C
• Mary E. Kenshalo

• Registered Nurse First Assistant in Palmer, AK
• Providers in Palmer, AK by specialty
• Registered Nurse First Assistant in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.