Provider Demographics
NPI:1609606912
Name:BESSETTE, ZACHARY PETTEWAY
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:PETTEWAY
Last Name:BESSETTE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:497 HOLLY GROVE DR
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-3202
Mailing Address - Country:US
Mailing Address - Phone:540-841-4917
Mailing Address - Fax:
Practice Address - Street 1:497 HOLLY GROVE DR
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-3202
Practice Address - Country:US
Practice Address - Phone:540-841-4917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-02
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110010656363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant