Active NPI
Nicole Renee Kellum, N.D.
- Naturopath
- Phoenix, AZ
National Provider Identifier
1043339468
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Naturopath
- License
- 09-1131
- Practice address
- 531 E Lynwood St
Phoenix, AZ 85004-1626 - Phone
- (603) 660-8972
- Fax
- (602) 626-3555
- NPI assigned
- Mar 28, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Naturopath | 175F00000X | 09-1131 | AZ | Primary |
Addresses
Primary practice location
531 E Lynwood St
Phoenix, AZ 85004-1626
Mailing address
10435 N Scottsdale Rd
Scottsdale, AZ 85253-4530
Phone (603) 660-8972
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 |
|---|---|---|---|
| 09-1131 | AZ | MD | Naturopath |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175040000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1376956800000",
"number": "1043339468",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10435 N SCOTTSDALE RD",
"city": "SCOTTSDALE",
"state": "AZ",
"postal_code": "852534530",
"telephone_number": "603-660-8972"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "531 E LYNWOOD ST",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850041626",
"telephone_number": "603-660-8972",
"fax_number": "602-626-3555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLUM",
"first_name": "NICOLE",
"middle_name": "RENEE",
"name_prefix": "Dr.",
"credential": "N.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-28",
"last_updated": "2013-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "175F00000X",
"taxonomy_group": "",
"desc": "Naturopath",
"state": "AZ",
"license": "09-1131",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.