Provider Demographics
NPI:1902522295
Name:MARLOW, KELLEY MARIE (PNP-PC)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:MARIE
Last Name:MARLOW
Suffix:
Gender:F
Credentials:PNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4690 S LAKESHORE DR APT 3050
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-1170
Mailing Address - Country:US
Mailing Address - Phone:516-784-8853
Mailing Address - Fax:
Practice Address - Street 1:333 E CAMELBACK RD STE 175
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1623
Practice Address - Country:US
Practice Address - Phone:602-840-3120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRNP260103363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics