Provider Demographics
NPI:1154168086
Name:MARTI, CHARISE ALICIA (APRN)
Entity type:Individual
Prefix:
First Name:CHARISE
Middle Name:ALICIA
Last Name:MARTI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:12120 STATE LINE RD STE 296
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209-1254
Mailing Address - Country:US
Mailing Address - Phone:657-375-3455
Mailing Address - Fax:888-779-3217
Practice Address - Street 1:12120 STATE LINE RD STE 296
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66209-1254
Practice Address - Country:US
Practice Address - Phone:657-375-3455
Practice Address - Fax:888-779-3217
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2012023983163W00000X
KS14-116708-121163W00000X
KS53-83411-121363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse