Healthcare Provider Details

I. General information

NPI: 1609606912
Provider Name (Legal Business Name): ZACHARY PETTEWAY BESSETTE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2024
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 E CLAY ST
RICHMOND VA
23298-5071
US

IV. Provider business mailing address

1213 E CLAY ST
RICHMOND VA
23298-5071
US

V. Phone/Fax

Practice location:
  • Phone: 804-827-1207
  • Fax: 804-827-0285
Mailing address:
  • Phone: 540-841-4917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number0110010656
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110010656
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: