Healthcare Provider Details

I. General information

NPI: 1306765862
Provider Name (Legal Business Name): ZACHARIAH KACHEMOV NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4633 BRAMBLETON AVE STE 100
ROANOKE VA
24018-3410
US

IV. Provider business mailing address

4633 BRAMBLETON AVE STE 100
ROANOKE VA
24018-3410
US

V. Phone/Fax

Practice location:
  • Phone: 540-655-1888
  • Fax: 844-212-0402
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024198057
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: