Healthcare Provider Details

I. General information

NPI: 1336870641
Provider Name (Legal Business Name): ZACHARY LOVELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2022
Last Update Date: 06/19/2022
Certification Date: 06/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1065 HWY 248
BRANSON MO
65616-8398
US

IV. Provider business mailing address

523 CREEKSIDE TRCE
SADDLEBROOKE MO
65630-3096
US

V. Phone/Fax

Practice location:
  • Phone: 417-332-3639
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2022022672
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: