Provider Demographics
NPI:1073925319
Name:MARSHALL, MATTHEW (FNP)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 STATE HIGHWAY 248
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-8398
Mailing Address - Country:US
Mailing Address - Phone:417-332-3639
Mailing Address - Fax:
Practice Address - Street 1:1065 STATE HIGHWAY 248
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-8398
Practice Address - Country:US
Practice Address - Phone:417-332-3639
Practice Address - Fax:417-332-3639
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5594363L00000X
MO2025017576363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner