Marisa Ebersole

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

34201 Issued in TN

Practice address

1193 Fort Campbell Blvd
Clarksville, TN 37042-8880

Phone

(931) 648-4838

NPI assigned

Jul 10, 2023

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

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Crossroads Urgent Care PLLCGroup PAC ID 8325117484, 181 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Crossroads Urgent Care PLLC

  • Family Medicine Physician
  • Murfreesboro, TN
  • NPI 1366644361
  Medicare reassignment Care Compare group NPD
• Crossroads Urgent Care PLLC

  • Rural Health Clinic/Center
  • South Pittsburg, TN
  • NPI 1427781129

  Family

  NPD

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

{
    "created_epoch": "1688947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688947200000",
    "number": "1144908260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1193 FORT CAMPBELL BLVD",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370428880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1193 FORT CAMPBELL BLVD",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370428880",
            "telephone_number": "931-648-4838"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2147 Wilma Rudolph Blvd",
            "address_purpose": "LOCATION",
            "city": "Clarksville",
            "state": "TN",
            "postal_code": "370406718",
            "country_code": "US",
            "telephone_number": "931-241-4115",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1466 Tiny Town Rd",
            "address_purpose": "LOCATION",
            "city": "Clarksville",
            "state": "TN",
            "postal_code": "370428291",
            "country_code": "US",
            "telephone_number": "931-503-7093",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1690 Fort Campbell Blvd",
            "address_purpose": "LOCATION",
            "city": "Clarksville",
            "state": "TN",
            "postal_code": "370427531",
            "country_code": "US",
            "telephone_number": "931-648-4838",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2224 Madison St Ste B",
            "address_purpose": "LOCATION",
            "city": "Clarksville",
            "state": "TN",
            "postal_code": "370438043",
            "country_code": "US",
            "telephone_number": "931-503-7015",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EBERSOLE",
        "first_name": "MARISA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-10",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "34201",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Briauna Naona Ealy, LMSW, LADAC II
• Lucinda Ann Earlywine I
• John Daniel Eaton
• Sherry Laree Eaton
• Haven Miracle-Blaise Eaves
• Bethany Eblen
• Sefarrah Dionne Echols, RBT-24-353040
• Elizabeth Louise Eckart
• Eclipse Pain Network, LLC
• Andrea L Edelstein, DMD

• Family Nurse Practitioner in Clarksville, TN
• Providers in Clarksville, TN by specialty
• Family Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.