| Doctor Name: | MR. KELLY MARCUM |
| NPI Number: | 1619973930 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | NP |
| License Number: | RN036514 |
| Business Practice Address: | 2931 S Hwy 260 Overgaard, AZ - 85933 |
| Business Phone Number: | 9285363616 |
| Business Fax Number: | 9285363615 |
| Mailing Address: | 2200 E Show Low Lake Rd, SHOW LOW |
| State: | AZ |
| Postal Code: | 85901 |
| Phone Number: | 9285376978 |
| Fax Number: | 9285374205 |
| NPI Enumeration Date: | 06/22/2005 |
| NPI Last Update Date: | 12/30/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | RN036514 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |