Healthcare Provider Details

I. General information

NPI: 1134045792
Provider Name (Legal Business Name): ZACHARY ELLIOT OWEN CST, CSFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 SHORT LEAF LN
ORONOGO MO
64855-6001
US

IV. Provider business mailing address

701 SHORT LEAF LN
ORONOGO MO
64855-6001
US

V. Phone/Fax

Practice location:
  • Phone: 501-574-1294
  • Fax:
Mailing address:
  • Phone: 501-574-1294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: