Provider Demographics
NPI:1881184893
Name:RUMBARGER, MARLEY (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MARLEY
Middle Name:
Last Name:RUMBARGER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 BYHALIA CREEK FARMS RD E
Mailing Address - Street 2:
Mailing Address - City:BYHALIA
Mailing Address - State:MS
Mailing Address - Zip Code:38611-7065
Mailing Address - Country:US
Mailing Address - Phone:662-255-0353
Mailing Address - Fax:
Practice Address - Street 1:188 STARLYN AVE
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652-2436
Practice Address - Country:US
Practice Address - Phone:662-486-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902625363L00000X
MSBASS-L7SK8T207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine