Provider Demographics
NPI:1033694856
Name:WATT, ZACHARY CHARLES (NP)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:CHARLES
Last Name:WATT
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11040 OAKMONT ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-1100
Mailing Address - Country:US
Mailing Address - Phone:913-291-2819
Mailing Address - Fax:913-291-1506
Practice Address - Street 1:11040 OAKMONT ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-6621
Practice Address - Country:US
Practice Address - Phone:913-291-2819
Practice Address - Fax:913-291-1506
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS53-78356-081363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner