Provider Demographics
NPI:1790422608
Name:WIGHT, ZACHARY (MSN, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:WIGHT
Suffix:
Gender:M
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5825 DELMONICO DR STE 320
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-2242
Mailing Address - Country:US
Mailing Address - Phone:719-505-5116
Mailing Address - Fax:
Practice Address - Street 1:5825 DELMONICO DR STE 320
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-2244
Practice Address - Country:US
Practice Address - Phone:719-505-5116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-13
Last Update Date:2024-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0997547-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty