MEDICARE: MR. KEVIN JAMES MARSTON AGACNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	249498	AZ
2	363LA2100X	Acute Care Nurse Practitioner	249498	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720688443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEVIN JAMES MARSTON AGACNP-BC

Provider Business Mailing Address
First Line	:	13555 W MCDOWELL RD
Second Line	:	STE 205
City	:	GOODYEAR
State	:	AZ
Zip	:	85395-2626
Country	:	US
Telephone Number	:	207-831-2002
Fax Number	:

Provider Business Practice Location Address
First Line	:	6602 E PHELPS RD
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85254-5659
Country	:	US
Telephone Number	:	207-831-2002
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2020
Last Update Date	:	11/30/2021

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