=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356268957
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ZAKRY RANBERGER RN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2026
-----------------------------------------------------
Last Update Date | 07/03/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2670 CRESTWOOD DR APT 3
-----------------------------------------------------
City | POPLAR BLUFF
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63901-2376
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-397-8362
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2670 CRESTWOOD DR APT 3
-----------------------------------------------------
City | POPLAR BLUFF
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63901-2376
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-397-8362
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 2021000806
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------