Individual provider Active NPI

Marissa Dawn Walker, FNP-C

  • Family Nurse Practitioner
  • Novi, MI
National Provider Identifier
1487261392
Registry record updated Feb 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704304415 Issued in MI
Practice address
41850 W 11 Mile Rd Ste 202
Novi, MI 48375-1857
Phone
(248) 860-4634
NPI assigned
Sep 24, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 4704304415 MI Primary

Addresses

Primary practice location

41850 W 11 Mile Rd Ste 202
Novi, MI 48375-1857

Mailing address

41850 W 11 Mile Rd Ste 202
Novi, MI 48375-1857

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, NC2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20201215001841 MI Practitioner - Nurse Practitioner 2860804903 Reassigns benefits to 2 organizations
I20250117002642 NC Practitioner - Nurse Practitioner 2860804903 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Theoria MedicalGroup PAC ID 5395098339, 317 clinicians

Practice addresses (Care Compare)

237 Tryon Rd
Rutherfordton, NC 28139-3058
Phone (248) 660-1220

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Theoria Medical Nurse Practitioner CurrentSince Dec 1, 2020 Accepting new patients
Complexcare Medical Group Midwest H PLLC CurrentSince Jun 10, 2025 Accepting new patients
Theoria Medical Nurse Practitioner Past Accepting new patients

Locations

5655 Clarkston Rd
Clarkston, MI 48348
Phone (810) 623-5216

6700 W Outer Dr
Detroit, MI 48235
Phone (313) 836-1700

1330 Grand Pointe Ct
Grand Blanc, MI 48439
Phone (810) 344-3518

3139 E Baldwin Rd
Grand Blanc, MI 48439
Phone (810) 445-5300

41800 W 11 Mile Rd
Ste 109
Novi, MI 48375
Phone (833) 578-2763

41850 W 11 Mile Rd
Ste 202
Novi, MI 48375
Phone (248) 380-0867

1901 N Telegraph Rd
Waterford, MI 48328
Phone (248) 732-0906

969 Cox Rd
Gastonia, NC 28054
Phone (704) 266-8596

1839 Onslow Dr
Jacksonville, NC 28540
Phone (910) 455-3610

430 W Health Center Dr
Nags Head, NC 27959
Phone (252) 441-3116

1010 Lakeview Dr
Pineville, NC 28134
Phone (704) 889-2273

237 Tryon Rd
Rutherfordton, NC 28139
Phone (828) 286-7200

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1600905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707177600000",
    "number": "1487261392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41850 W 11 MILE RD STE 202",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483751857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41850 W 11 MILE RD STE 202",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483751857",
            "telephone_number": "248-860-4634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALKER",
        "first_name": "MARISSA",
        "middle_name": "DAWN",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-24",
        "last_updated": "2024-02-06",
        "certification_date": "2024-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704304415",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Novi, MI

Sources for this page

Verify at the official NPI Registry.