Provider Demographics
NPI:1841844230
Name:TIMM, ZACKERY (FNP-C)
Entity type:Individual
Prefix:
First Name:ZACKERY
Middle Name:
Last Name:TIMM
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 1:2002 WEST CO. RD. 0 N/S
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IN
Mailing Address - Zip Code:46041
Mailing Address - Country:US
Mailing Address - Phone:877-449-7473
Mailing Address - Fax:
Practice Address - Street 1:2002 WEST CO. RD. 0 N/S
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IN
Practice Address - Zip Code:46041
Practice Address - Country:US
Practice Address - Phone:877-449-7473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71009160A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily