Provider Demographics
NPI:1447926639
Name:POWELL, ZACHARY RICHARD
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:RICHARD
Last Name:POWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9205 E 94TH ST N
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-7298
Mailing Address - Country:US
Mailing Address - Phone:918-640-3240
Mailing Address - Fax:
Practice Address - Street 1:9205 E 94TH ST N
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-7298
Practice Address - Country:US
Practice Address - Phone:918-640-3240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program