Basic Information
| Provider Information | |||||||||
| NPI: | 1447910708 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOSES | ||||||||
| FirstName: | ZACHARY | ||||||||
| MiddleName: | EARL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2519 TOLL GATE RD NE APT A | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358011529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2566772881 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1559 SPARTA ST | ||||||||
| Address2: | |||||||||
| City: | MCMINNVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371101316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9318154000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2021 | ||||||||
| LastUpdateDate: | 12/28/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 1-136500 | AL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LG0600X | 1-136500 | AL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | 363LA2100X | 1-136500 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.