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MR. KELLY MARCUM NP
Family >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing ProvidersRegistrant NPI Number: 1619973930
Individual Registrant:MR. KELLY MARCUM NP
Gender: M
Not Sole Proprietor
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
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
Tel: 928-537-6978 Fax: 928-537-4205
Registration Information:
NPI: 1619973930
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Family | AZ | RN036514 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
