Individual
MR. KELLY MARCUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
2931 S HWY 260, OVERGAARD, AZ 85933
(928) 536-3616
(928) 536-3615
Mailing address
2200 E SHOW LOW LAKE RD, SHOW LOW, AZ 85901
(928) 537-6978
(928) 537-4205
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN036514
AZ
Other
Enumeration date
06/22/2005
Last updated
12/30/2013
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