Provider Demographics
NPI:1063068419
Name:NETHERCUTT, ZACHARY GRANT (CHILD/ ADULT CIS)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:GRANT
Last Name:NETHERCUTT
Suffix:
Gender:M
Credentials:CHILD/ ADULT CIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 ADDISON DR
Mailing Address - Street 2:
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-1602
Mailing Address - Country:US
Mailing Address - Phone:870-238-1135
Mailing Address - Fax:870-238-1139
Practice Address - Street 1:661 ADDISON DR
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-1602
Practice Address - Country:US
Practice Address - Phone:870-238-1135
Practice Address - Fax:870-238-1139
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator