Provider Demographics
NPI:1770229676
Name:MARCUM, KATHRYN RILEY
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:RILEY
Last Name:MARCUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 835
Mailing Address - Street 2:
Mailing Address - City:MULLENS
Mailing Address - State:WV
Mailing Address - Zip Code:25882-0835
Mailing Address - Country:US
Mailing Address - Phone:304-294-5610
Mailing Address - Fax:304-294-2040
Practice Address - Street 1:3776 MOUNTAINEER HIGHWAY
Practice Address - Street 2:
Practice Address - City:MABEN
Practice Address - State:WV
Practice Address - Zip Code:25870
Practice Address - Country:US
Practice Address - Phone:304-294-5610
Practice Address - Fax:304-294-2040
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant