Provider Demographics
NPI:1699500637
Name:CULP, ZACHARY DAVID (PSS)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:DAVID
Last Name:CULP
Suffix:
Gender:M
Credentials:PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:699 RANCH RD
Mailing Address - Street 2:
Mailing Address - City:VINE GROVE
Mailing Address - State:KY
Mailing Address - Zip Code:40175-1037
Mailing Address - Country:US
Mailing Address - Phone:270-872-5656
Mailing Address - Fax:
Practice Address - Street 1:537 BELLWOOD DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2336
Practice Address - Country:US
Practice Address - Phone:270-312-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1216849175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist