Provider Demographics
NPI:1942446653
Name:ZACHARIA, ACHAMMA (APN)
Entity Type:Individual
Prefix:MRS
First Name:ACHAMMA
Middle Name:
Last Name:ZACHARIA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MRS
Other - First Name:SHARRY
Other - Middle Name:ACHAMMA
Other - Last Name:ZACHARIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APN
Mailing Address - Street 1:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0853
Mailing Address - Country:US
Mailing Address - Phone:972-715-5000
Mailing Address - Fax:972-715-9976
Practice Address - Street 1:6606 LBJ FWY STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240
Practice Address - Country:US
Practice Address - Phone:972-715-5000
Practice Address - Fax:972-715-9976
Is Sole Proprietor?:No
Enumeration Date:2008-12-30
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP117049363LA2200X, 363L00000X
TX643866363LP2300X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX206167302Medicaid
TX206167304Medicaid
TX206167303Medicaid
TX206167311Medicaid
TXP01446809OtherRR
TX8N0232OtherBCBS
TX8430NZOtherBCBS
TX206167302Medicaid
TX362829YK6UMedicare PIN
TX8L22600Medicare PIN
TXTXB155713Medicare PIN
TX206167302Medicaid
TX8L22631Medicare PIN