MR. KELLY MARCUM (NPI# 1619973930) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619973930 |
| Entity Type | Individual |
| Full Name | MR. KELLY MARCUM |
| Credential | NP |
| Practice Address |
2931 S Hwy 260 Overgaard AZ 85933 |
| Mailing Address |
2200 E Show Low Lake Rd Show Low AZ 85901 |
| Practice Telephone | 9285363616 |
| Practice Fax Number | 9285363615 |
| Mailing Telephone | 9285376978 |
| Mailing Fax Number | 9285374205 |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2013-12-30 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
RN036514 | AZ | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
2931 S HWY 260 |
| City | OVERGAARD |
| State | AZ |
| Zip Code | 85933 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417570664 | Compass Medical Center Heber, Pllc | General Practice | 2931 Highway 260, Overgaard, AZ 85933 | 2020-05-22 |
| 1417513904 | N & R Bryce Enterprises LLC | Pharmacy | 2841 Highway 260 Suite 2, Overgaard, AZ 85933 | 2019-05-10 |
| 1396136818 | Compassion Services Inc | Non-emergency Medical Transport (VAN) | 3680 Buckskin Rd, Overgaard, AZ 85933 | 2015-02-06 |
| 1679744940 | Ryan C Stuart Od PC | Optometrist | 2824 Highway 260, Suite 5, Overgaard, AZ 85933 | 2008-03-14 |
| 1942382890 | Marshall M. Willis | Chiropractor | 2947 Hwy 260, #3, Overgaard, AZ 85933 | 2006-10-19 |
| 1164489050 | Aaron C Bornstein | Family Medicine | 2352 Quarter Horse Trail, Overgaard, AZ 85933 | 2006-04-26 |
| 1770566705 | Heber-overgaard Fire District | Ambulance | 2061 Lumber Valley Rd, Overgaard, AZ 85933 | 2005-11-23 |
| 1326549031 | Summit Healthcare Association | Non-Pharmacy Dispensing Site | 2352 Quarter Horse Trail, Overgaard, AZ 85933 | 2018-02-27 |
| 1720515828 | Ramon Schafer Jr. | Family Medicine | 2352 Quarter Horse Trail, Overgaard, AZ 85933 | 2017-05-19 |
| 1043425622 | Marshall M. Willis D.c., P.C. | Chiropractor | 2947 Hwy 260, 3, Overgaard, AZ 85933 | 2007-05-14 |
| Find all providers in zip 85933 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538760921 | Valerie Pong | Nurse Practitioner | 530 Karen Way, Bullhead City, AZ 86442-6177 | 2020-11-03 |
| 1407456783 | Brenna Michelle Clements | Nurse Practitioner | 3226 W Donatello Dr, Phoenix, AZ 85086-2200 | 2020-10-27 |
| 1902406499 | Kimberly Brown | Nurse Practitioner | 4315 N Adams St, Kingman, AZ 86409-2610 | 2020-10-26 |
| 1669071361 | Harmony Clinic and Medspa | Nurse Practitioner | 670 E 32nd St Ste 8, Yuma, AZ 85365-3576 | 2020-10-22 |
| 1528667615 | Elena Eloriaga | Nurse Practitioner | 1925 S Coronado Rd Apt 2133, Gilbert, AZ 85295-2219 | 2020-10-20 |
| 1942809165 | Barbara Powers | Nurse Practitioner | 9251 E Snyder Rd, Tucson, AZ 85749-9443 | 2020-10-19 |
| 1861091175 | Guiding Light Holistic Healthcare | Nurse Practitioner | 9758 S La Rosa Dr, Tempe, AZ 85284-5004 | 2020-10-19 |
| 1598364838 | Ryan Nelson Sutton | Nurse Practitioner | 3719 E Loma Vista St, Gilbert, AZ 85295-4675 | 2020-10-19 |
| 1942808431 | Vera Adell Dujmic | Nurse Practitioner | 10959 E Actinidia St, Tucson, AZ 85747-8862 | 2020-10-15 |
| 1376141184 | Laura E Ahumada | Nurse Practitioner | 3417 N Sand Creek Ct, Tucson, AZ 85745-7126 | 2020-10-14 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.