Kelly Marcum, NP
Individual provider Active NPI Family Nurse Practitioner · Overgaard, AZ
NPI 1619973930 · NPPES record last updated Dec 30, 2013
Key facts
- NPI
- 1619973930
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- RN036514 (AZ)
- Practice address
- 2931 S Hwy 260
Overgaard, AZ 85933 - Phone
- (928) 536-3616
- Fax
- (928) 536-3615
- NPI assigned
- Jun 22, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| White Mountain Emergency Physicians, PC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | RN036514 | AZ | Yes |
Addresses
Primary practice location
2931 S Hwy 260
Overgaard, AZ 85933
Mailing address
2200 E Show Low Lake Rd
Show Low, AZ 85901
Phone (928) 537-6978
Other providers in Overgaard, AZ
- Audrey Frances Cosper
- Dutcher Enterprises
- Harmony Rural Healthcare
- Heber-Overgaard Fire District
- Daniel Kuhse
- Marshall M. Willis D.C., P.C.
- Mitchell F Horan MD PC
- Mogollon Family Dentistry
- Mogollon Family Dentistry
- Mountain Top Transport Services, LLC
All providers in Overgaard, AZ · Family Nurse Practitioner in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 30, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.