Provider Demographics
NPI:1376160986
Name:NUNNALLY, ZACHARY (DEM)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:NUNNALLY
Suffix:
Gender:M
Credentials:DEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 1/2 MAIN ST E
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-3032
Mailing Address - Country:US
Mailing Address - Phone:304-207-4984
Mailing Address - Fax:
Practice Address - Street 1:603 N MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:MOUNT HOPE
Practice Address - State:WV
Practice Address - Zip Code:25880-1014
Practice Address - Country:US
Practice Address - Phone:304-207-4984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2023-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife