Provider Demographics
NPI:1861012015
Name:KIETZMAN, ZACHARY AUSTIN (NP-C)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:AUSTIN
Last Name:KIETZMAN
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:ZACHARY
Other - Middle Name:AUSTIN
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:87B OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-6913
Mailing Address - Country:US
Mailing Address - Phone:803-629-4134
Mailing Address - Fax:
Practice Address - Street 1:3 FARM GLEN BLVD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-1285
Practice Address - Country:US
Practice Address - Phone:803-629-4134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-17
Last Update Date:2023-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT209707163W00000X
GARN236642363LG0600X, 163W00000X, 363LP2300X
CT12068363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology