Healthcare Provider Details

I. General information

NPI: 1619732260
Provider Name (Legal Business Name): LAURA KATHERINE MARCUM APRN, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

3101 KIRKLEVINGTON DR APT 219
LEXINGTON KY
40517-2491
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-5956
  • Fax: 859-323-1080
Mailing address:
  • Phone: 859-494-4392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4023937
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number1152107
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: