Provider Demographics
NPI:1821565185
Name:WOTHERSPOON, ZACHARY (DNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:WOTHERSPOON
Suffix:
Gender:M
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 WOODLOT CT
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-8540
Mailing Address - Country:US
Mailing Address - Phone:540-226-0642
Mailing Address - Fax:
Practice Address - Street 1:20 DOC STONE RD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22556-4515
Practice Address - Country:US
Practice Address - Phone:540-602-7766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024176306363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily