Provider Demographics
NPI:1801444070
Name:MANLEY, ZACHARY (FNP-C)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:MANLEY
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSON
Mailing Address - State:WV
Mailing Address - Zip Code:25661-3601
Mailing Address - Country:US
Mailing Address - Phone:304-235-2930
Mailing Address - Fax:304-235-0538
Practice Address - Street 1:300 PROSPERITY LN STE 207
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-3743
Practice Address - Country:US
Practice Address - Phone:304-752-8202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV103957363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily