NPIMap

Organization Active NPI

Sycamore Avenue Medical Center, PLLC

  • Family Nurse Practitioner
  • Kingman, AZ
National Provider Identifier
1245762491
Registry record updated Jan 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP3349 Issued in AZ
Legal business name
SYCAMORE AVENUE MEDICAL CENTER, PLLC
Practice address
975 Sycamore Ave
Kingman, AZ 86409-3548
Phone
(928) 692-1900
Fax
(928) 681-1922
NPI assigned
Mar 28, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Felicia Marie Murray
Title
Office Manager
Phone
(928) 692-1900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X AP3349 AZ Primary

Addresses

Primary practice location

975 Sycamore Ave
Kingman, AZ 86409-3548

Mailing address

975 Sycamore Ave
Kingman, AZ 86409-3548
Phone (928) 692-1900

National Provider Directory

National Provider Directory

Locations

975 Sycamore Ave
Kingman, AZ 86409
Phone (928) 692-1900

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1490659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610323200000",
    "number": "1245762491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "975 SYCAMORE AVE",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864093548",
            "telephone_number": "928-692-1900",
            "fax_number": "928-681-1922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "975 SYCAMORE AVE",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864093548",
            "telephone_number": "928-692-1900",
            "fax_number": "928-681-1922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SYCAMORE AVENUE MEDICAL CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-28",
        "last_updated": "2021-01-11",
        "certification_date": "2021-01-11",
        "status": "A",
        "authorized_official_last_name": "MURRAY",
        "authorized_official_first_name": "FELICIA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "928-692-1900"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "AP3349",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingman, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.