Provider Demographics
NPI:1841579588
Name:BETTERS, ZACHARY (PA)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:BETTERS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6030 W HIGHWAY 74
Practice Address - Street 2:STE A
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-3468
Practice Address - Country:US
Practice Address - Phone:704-246-2777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-03021363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1841579588Medicaid
SC2397PAMedicaid
NCNC3154NMedicare PIN
NCNC3154CMedicare PIN
NCNC3154FMedicare PIN
NCNC3154EMedicare PIN
NCNC3154AMedicare PIN
NCNC3154KMedicare PIN
NCNC3154MMedicare PIN
NC1841579588Medicaid
NCNC3154DMedicare PIN
NCNC3154GMedicare PIN
SC2397PAMedicaid
NCNC3154IMedicare PIN
NCNC3154BMedicare PIN
NCNC3154LMedicare PIN