Kelly Marcum, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN036514 Issued in AZ

Practice address

2931 S Hwy 260
Overgaard, AZ 85933

Phone

(928) 536-3616

Fax

(928) 536-3615

NPI assigned

Jun 22, 2005

Last updated

Dec 30, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• White Mountain Emergency Physicians, PC

  • Emergency Medicine Physician
  • Show Low, AZ
  • NPI 1710964101
  NPD (past)

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

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1388361600000",
    "number": "1619973930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 E SHOW LOW LAKE RD",
            "city": "SHOW LOW",
            "state": "AZ",
            "postal_code": "85901",
            "telephone_number": "928-537-6978",
            "fax_number": "928-537-4205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2931 S HWY 260",
            "city": "OVERGAARD",
            "state": "AZ",
            "postal_code": "85933",
            "telephone_number": "928-536-3616",
            "fax_number": "928-536-3615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARCUM",
        "first_name": "KELLY",
        "name_prefix": "Mr.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-22",
        "last_updated": "2013-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "RN036514",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Audrey Frances Cosper, CD(DONA)
• Dutcher Enterprises (Silver Creek Pharmacy #2)
• Harmony Rural Healthcare
• Heber-Overgaard Fire District
• Daniel Kuhse
• Linda Marczeski, BSN, RN
• Marshall M. Willis D.C., P.C. (Mountain High Chiropractic)
• Mitchell F Horan MD PC
• Mogollon Family Dentistry
• Mogollon Family Dentistry

• Family Nurse Practitioner in Overgaard, AZ
• Providers in Overgaard, AZ by specialty
• Family Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 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.

Verify at the official NPI Registry.