Healthcare Provider Details

I. General information

NPI: 1295571313
Provider Name (Legal Business Name): ZACHARY SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 HIGHLAND MEADOWS WAY
PARROTTSVILLE TN
37843-2260
US

IV. Provider business mailing address

1007 HIGHLAND MDW
PARROTTSVILLE TN
37843-2260
US

V. Phone/Fax

Practice location:
  • Phone: 334-456-2332
  • Fax:
Mailing address:
  • Phone: 334-456-2332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number37092
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: