Provider Demographics
NPI:1457530289
Name:MARCUM, LOU BERNICE (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:LOU
Middle Name:BERNICE
Last Name:MARCUM
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:LOU
Other - Middle Name:B
Other - Last Name:POTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 749306
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1762 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-2231
Practice Address - Country:US
Practice Address - Phone:864-968-9144
Practice Address - Fax:864-968-9244
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV62746363LF0000X
SC30040363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0126989Medicaid
WV3810025066Medicaid
KY7100350590Medicaid
OH0126989Medicaid