Provider Demographics
NPI:1699576603
Name:CAGLE, ZACHARY WYATT
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:WYATT
Last Name:CAGLE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4522 CAMPGROUND RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:AR
Mailing Address - Zip Code:72007-9145
Mailing Address - Country:US
Mailing Address - Phone:870-918-6970
Mailing Address - Fax:870-918-6970
Practice Address - Street 1:4522 CAMPGROUND RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:AR
Practice Address - Zip Code:72007-9145
Practice Address - Country:US
Practice Address - Phone:870-918-6970
Practice Address - Fax:870-918-6970
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR76951163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse