Active NPI
Marissa Mirakian
- Nurse Practitioner
- Kansas City, MO
National Provider Identifier
1679053706
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 2018032917
- Practice address
- 2401 Gillham Rd
Kansas City, MO 64108 - Phone
- (816) 302-8547
- NPI assigned
- Aug 17, 2018
- 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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 2018032917 | MO | Primary |
Addresses
Primary practice location
2401 Gillham Rd
Kansas City, MO 64108
Mailing address
2401 Gillham Rd
Provider Enrollment
Kansas City, MO 64108-4619
Phone (816) 701-5200
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 |
|---|---|---|---|
| 2018032917 | MO | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1534464000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1537747200000",
"number": "1679053706",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2401 GILLHAM RD",
"address_2": "PROVIDER ENROLLMENT",
"city": "KANSAS CITY",
"state": "MO",
"postal_code": "641084619",
"telephone_number": "816-701-5200",
"fax_number": "816-302-9939"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2401 GILLHAM RD",
"city": "KANSAS CITY",
"state": "MO",
"postal_code": "64108",
"telephone_number": "816-302-8547"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIRAKIAN",
"first_name": "MARISSA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-08-17",
"last_updated": "2018-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MO",
"license": "2018032917",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kansas City, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.