Provider Demographics
NPI:1952306359
Name:WEBB, MARCUS D (FNP)
Entity Type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:D
Last Name:WEBB
Suffix:
Gender:M
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:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37857-0850
Mailing Address - Country:US
Mailing Address - Phone:423-772-3276
Mailing Address - Fax:423-772-4816
Practice Address - Street 1:152 HIGHWAY 143
Practice Address - Street 2:
Practice Address - City:ROAN MOUNTAIN
Practice Address - State:TN
Practice Address - Zip Code:37687-3002
Practice Address - Country:US
Practice Address - Phone:423-772-3276
Practice Address - Fax:423-772-4816
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN100781363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3348529Medicaid
TN4063399OtherBCBST
3703865Medicare PIN
P00009798Medicare PIN
3348529Medicare ID - Type Unspecified
TN3348529Medicaid
P87925Medicare UPIN
33485291Medicare PIN