Healthcare Provider Details

I. General information

NPI: 1003546698
Provider Name (Legal Business Name): ZACKARY BEVER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6280 GRELOT RD
MOBILE AL
36609-3614
US

IV. Provider business mailing address

1500 1ST AVE N UNIT 3
BIRMINGHAM AL
35203-1866
US

V. Phone/Fax

Practice location:
  • Phone: 251-288-5606
  • Fax:
Mailing address:
  • Phone: 200-554-5508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-171987
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: