Individual
MRS. KATY LEANNE MARCUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
4359 NEW SHEPHERDSVILLE RD UNIT 255, BARDSTOWN, KY 40004-8004
(502) 350-5800
(502) 350-5820
Mailing address
PO BOX 936, LONDON, KY 40743-0936
(606) 330-7835
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3014496
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001402203
ANTHEM PROVIDER ID NUMBER
—
05
—
0411379
—
OH
05
—
300040518
—
IN
01
—
3255677
HUMANA PROVIDER ID NUMBER
—
05
—
7100676370
—
KY
01
—
CS2026700184
CARESOURCE PROVIDER ID NUMBER
—
Enumeration date
07/14/2020
Last updated
02/01/2023
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