Healthcare Provider Details

I. General information

NPI: 1942446653
Provider Name (Legal Business Name): ACHAMMA ZACHARIA APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHARRY ACHAMMA ZACHARIA APN

II. Dates (important events)

Enumeration Date: 12/30/2008
Last Update Date: 05/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6606 LBJ FWY STE 200
DALLAS TX
75240
US

IV. Provider business mailing address

PO BOX 840853
DALLAS TX
75284-0853
US

V. Phone/Fax

Practice location:
  • Phone: 972-715-5000
  • Fax: 972-715-9976
Mailing address:
  • Phone: 972-715-5000
  • Fax: 972-715-9976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP117049
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number643866
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number643866
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP117049
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: