Active NPI
Marley Ann Stephan, FNP
- Family Nurse Practitioner
- Licking, MO
National Provider Identifier
1104568914
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 2022012951
- Practice address
- 255 W Highway 32
Licking, MO 65542-9076 - Phone
- (573) 674-4470
- NPI assigned
- Apr 12, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 2022012951 | MO | Primary |
Addresses
Primary practice location
255 W Highway 32
Licking, MO 65542-9076
Mailing address
1126 Highway P
Salem, MO 65560-8267
Phone (573) 674-4470
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2022012951 | MO | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1649721600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1649721600000",
"number": "1104568914",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1126 HIGHWAY P",
"city": "SALEM",
"state": "MO",
"postal_code": "655608267",
"telephone_number": "573-674-4470"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "255 W HIGHWAY 32",
"city": "LICKING",
"state": "MO",
"postal_code": "655429076",
"telephone_number": "573-674-4470"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STEPHAN",
"first_name": "MARLEY",
"middle_name": "ANN",
"credential": "FNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-04-12",
"last_updated": "2022-04-12",
"certification_date": "2022-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MO",
"license": "2022012951",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Licking, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.