Provider Demographics
NPI:1912722927
Name:DAVIS, ZACHARY (NP)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1770 LAKE CUMBERLAND RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:KY
Mailing Address - Zip Code:40456-8431
Mailing Address - Country:US
Mailing Address - Phone:606-256-7488
Mailing Address - Fax:606-256-2753
Practice Address - Street 1:1770 LAKE CUMBERLAND RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:KY
Practice Address - Zip Code:40456-8431
Practice Address - Country:US
Practice Address - Phone:606-256-7488
Practice Address - Fax:606-256-2753
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY4030559363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily