Individual provider Active NPI

Marissa Lynne Henderson, MSN, APRN, FNP-C

  • Nurse Practitioner
  • Atlanta, GA
National Provider Identifier
1518502475
Registry record updated Sep 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
AP143723 Issued in TX
Practice address
1055 Howell Mill Rd NW
Atlanta, GA 30318-5557
Phone
(866) 849-0692
NPI assigned
Nov 14, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2025

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

Specialties & licenses 15

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 2025008125 MO
Nurse Practitioner 363L00000X AP143723 TX Primary
Nurse Practitioner 363L00000X AP61670672 WA
Nurse Practitioner 363L00000X 4035650 KY
Nurse Practitioner 363L00000X 38496 TN
Nurse Practitioner 363L00000X APRN11037949 FL
Nurse Practitioner 363L00000X 3-002294 AL
Nurse Practitioner 363L00000X 232324 AR
Nurse Practitioner 363L00000X 907312 MS
Nurse Practitioner 363L00000X C-APN.0103933-C-NP CO
Nurse Practitioner 363L00000X 30139 SC
Nurse Practitioner 363L00000X GAA-NP003247 GA
Nurse Practitioner 363L00000X 322525 AZ
Nurse Practitioner 363L00000X SP032352 PA
Nurse Practitioner 363L00000X 10041652 OR

Addresses

Primary practice location

1055 Howell Mill Rd NW
Atlanta, GA 30318-5557

Mailing address

PO Box 211699
Eagan, MN 55121-3699
Phone (866) 849-0692

Other practice location 1

609 Medical Center Dr Ste 2700
Decatur, TX 76234-3839
Phone (940) 627-8020

Other identifiers 2

IdentifierTypeStateIssuer
PENDINGMedicaidTX
PENDINGOtherTXBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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

Enrollment IDStateProvider typePAC IDDetails
I20191203002718 TX Practitioner - Nurse Practitioner 7113350208 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
3-002294ALMDNurse Practitioner
232324ARMDNurse Practitioner
322525AZMDNurse Practitioner
C-APN.0103933-C-NPCOMDNurse Practitioner
APRN11037949FLMDNurse Practitioner
GAA-NP003247GAMDNurse Practitioner
4035650KYMDNurse Practitioner
2025008125MOMDNurse Practitioner
907312MSMDNurse Practitioner
10041652ORMDNurse Practitioner
SP032352PAMDNurse Practitioner
38496TNMDNurse Practitioner
AP61670672WAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Devoted Medical Group of Texas Inc CurrentSince Aug 25, 2025 Accepting new patients
Aamir Zuberi MD PA CurrentSince Dec 1, 2019 Accepting new patients
Teresa N. Hill, M.D., P.a. Past Accepting new patients
Jon W Walker, M.D. Past Accepting new patients
Russell Doubrava DO PA PastSince Nov 1, 2019 Accepting new patients
NTSS-Pma PLLC Past Accepting new patients

Locations

609 Medical Center Dr
Ste 2700
Decatur, TX 76234
Phone (940) 627-0013

1201 Fannin St
Ste 262
Houston, TX 77002
Phone (714) 873-6202

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CHBDBA

Organizations & group practices 6

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": "1573689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758499200000",
    "number": "1518502475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 211699",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551213699",
            "telephone_number": "866-849-0692",
            "fax_number": "888-973-8821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 HOWELL MILL RD NW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303185557",
            "telephone_number": "866-849-0692"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "609 Medical Center Dr Ste 2700",
            "address_purpose": "LOCATION",
            "city": "Decatur",
            "state": "TX",
            "postal_code": "762343839",
            "country_code": "US",
            "telephone_number": "940-627-8020",
            "fax_number": "940-627-6730",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "MARISSA",
        "middle_name": "LYNNE",
        "credential": "MSN, APRN, FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-14",
        "last_updated": "2025-09-22",
        "certification_date": "2025-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MO",
            "license": "2025008125",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "AP143723",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WA",
            "license": "AP61670672",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "KY",
            "license": "4035650",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TN",
            "license": "38496",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "APRN11037949",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AL",
            "license": "3-002294",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AR",
            "license": "232324",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "907312",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CO",
            "license": "C-APN.0103933-C-NP",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "SC",
            "license": "30139",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "GAA-NP003247",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AZ",
            "license": "322525",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "SP032352",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OR",
            "license": "10041652",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "PENDING",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.