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MR. KELLY MARCUM NP

Family >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1619973930

Individual Registrant:
MR. KELLY  MARCUM NP
Gender: M
Not Sole Proprietor

Location and contact information for practice:
2931 S HWY 260  OVERGAARD, AZ 85933 US
Tel: 928-536-3616  Fax: 928-536-3615

Contact information for business:
2200 E SHOW LOW LAKE RD  SHOW LOW, AZ 85901 US
Tel: 928-537-6978  Fax: 928-537-4205

Registration Information:
NPI: 1619973930
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363LF0000XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
Family
AZRN036514

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




HEALTH CARE JOBS AZ - Page 1



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