Healthcare Provider Details

I. General information

NPI: 1356268957
Provider Name (Legal Business Name): ZAKRY RANBERGER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2670 CRESTWOOD DR APT 3
POPLAR BLUFF MO
63901-2376
US

IV. Provider business mailing address

2670 CRESTWOOD DR APT 3
POPLAR BLUFF MO
63901-2376
US

V. Phone/Fax

Practice location:
  • Phone: 573-397-8362
  • Fax:
Mailing address:
  • Phone: 573-397-8362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2021000806
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: