Basic Information
| Provider Information | |||||||||
| NPI: | 1104556331 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CONN | ||||||||
| FirstName: | ZACHARY | ||||||||
| MiddleName: | ANDREW | ||||||||
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| Credential: | DNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 377 SCR 57B | ||||||||
| Address2: | |||||||||
| City: | MIZE | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391165349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018328142 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2500 N STATE ST | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392164500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019841000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2022 | ||||||||
| LastUpdateDate: | 06/11/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 137064 | MS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.