Healthcare Provider Details

I. General information

NPI: 1801526751
Provider Name (Legal Business Name): ZACHARY HEATH MCBROOM APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 KELLEY HWY
FORT SMITH AR
72904-5000
US

IV. Provider business mailing address

8010 MASSARD RD
FORT SMITH AR
72916-7030
US

V. Phone/Fax

Practice location:
  • Phone: 479-785-5700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number122015
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: