Individual provider Active NPI

Mark M Marshall, FNP-C

  • Family Nurse Practitioner
  • Battle Ground, WA
National Provider Identifier
1548742190
Registry record updated Sep 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP61027928 Issued in WA
Practice address
2005 W Main St
Battle Ground, WA 98604-4311
Phone
(360) 882-2778
NPI assigned
Aug 30, 2018
Last updated
Sep 6, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 202001365NP-PP OR
Family Nurse Practitioner 363LF0000X 21984 SC
Family Nurse Practitioner 363LF0000X AP61027928 WA Primary
Primary Care Nurse Practitioner 363LP2300X AP61027928 WA

Addresses

Primary practice location

2005 W Main St
Battle Ground, WA 98604-4311

Mailing address

PO Box 4825
Portland, OR 97208-4825
Phone (360) 882-2778

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20200526002029 WA Practitioner - Nurse Practitioner 0143565424 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
21984SCMDDermatology Physician
AP61027928WAMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Vancouver Clinic Inc PS CurrentSince Sep 25, 2023 Accepting new patients
Sea Mar Community Health Centers Nurse Practitioner Current Accepting new patients
Sea Mar Community Health Centers Nurse Practitioner CurrentSince Mar 30, 2020 Accepting new patients
Sea Mar Community Health Centers CurrentSince Mar 30, 2020 Accepting new patients
The Vancouver Clinic Inc PS CurrentSince Sep 25, 2023 Accepting new patients
Booker Family Practice, LLC PastSince Oct 15, 2018 Accepting new patients

Locations

118 S Parkway Ave
Battle Ground, WA 98604
Phone (360) 342-8050

2005 W Main St
Battle Ground, WA 98604
Phone (360) 604-1600

700 NE 87th Ave
Vancouver, WA 98664
Phone (360) 397-1500

7410 Delaware Ln
Vancouver, WA 98664
Phone (360) 566-4402

Interoperability endpoints

  • Direct secure messaging: mmarshal@yourcarecommunity.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1535587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693958400000",
    "number": "1548742190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4825",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972084825",
            "telephone_number": "360-882-2778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2005 W MAIN ST",
            "city": "BATTLE GROUND",
            "state": "WA",
            "postal_code": "986044311",
            "telephone_number": "360-882-2778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARSHALL",
        "first_name": "MARK",
        "middle_name": "M",
        "name_prefix": "Mr.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-30",
        "last_updated": "2023-09-06",
        "certification_date": "2023-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OR",
            "license": "202001365NP-PP",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "21984",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP61027928",
            "primary": true
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "WA",
            "license": "AP61027928",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Battle Ground, WA

Sources for this page

Verify at the official NPI Registry.