Provider Demographics
NPI:1497703987
Name:MARCUM, AUDRA (ARNP)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:
Last Name:MARCUM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:AUDRA
Other - Middle Name:
Other - Last Name:SUMMERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:230 LEXINGTON GREEN CIR
Mailing Address - Street 2:STE 600
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3326
Mailing Address - Country:US
Mailing Address - Phone:859-971-4695
Mailing Address - Fax:859-971-4604
Practice Address - Street 1:166 PASADENA DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2973
Practice Address - Country:US
Practice Address - Phone:859-278-0319
Practice Address - Fax:859-277-9699
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004628363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78016938Medicaid
KY78016938Medicaid
Q69481Medicare UPIN