MEDICARE: MR. ZACHARY ALLEN HADDOX PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN.CNP.0037226	OH

General Provider Information

NPI Number	:	1518705938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ZACHARY ALLEN HADDOX PMHNP

Provider Business Mailing Address
First Line	:	6515 JUNIOR CT
Second Line	:
City	:	CARLISLE
State	:	OH
Zip	:	45005-4145
Country	:	US
Telephone Number	:	937-694-8757
Fax Number	:

Provider Business Practice Location Address
First Line	:	8940 KINGSRIDGE DR STE 106
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45458-1632
Country	:	US
Telephone Number	:	937-813-4485
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2024
Last Update Date	:	02/03/2026

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