Jennifer Zachary (NPI# 1922101054, PAC ID# 6709037310) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is NURSE PRACTITIONER.
| Nation Provider ID (NPI) | 1922101054 |
| PAC ID by PECOS | 6709037310 |
| Professional Enrollment ID | I20121107000715 |
| Full Name | Jennifer Zachary |
| Organization Legal Name | BLACKHAWK MANGUM LLC |
| Address |
1 Wickersham St Mangum OK 73554-9117 |
| Phone Number | 5807823533 |
| Gender | F |
| Graduation Year | 2001 |
| Primary Specialty | NURSE PRACTITIONER |
| Group Practice PAC ID | 2365477635 |
| Number of Group Practice Members | 7 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 371330 | QUARTZ MOUNTAIN MEDICAL CENTER |
| 370019 | GREAT PLAINS REGIONAL MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 1 Wickersham St, Mangum, OK 73554-9117 | 5807823533 | BLACKHAWK MANGUM LLC |
| Organization Legal Name | BLACKHAWK MANGUM LLC |
| Physicians | 4 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Manda Lea Stephens | Nurse Practitioner | Blackhawk Mangum LLC | 3000 N Main St, Quartz Mtn Med Ctr, Altus, OK 73521-1348 |
| Edwinna G Smith | Nurse Practitioner | Blackhawk Mangum LLC | 1 Wickersham St, Mangum, OK 73554-9117 |
| James L Johnson | Family Practice | Blackhawk Mangum LLC | 1 Wickersham St, Mangum, OK 73554-9117 |
| Street Address |
1 WICKERSHAM ST |
| City | MANGUM |
| State | OK |
| Zip | 73554-9117 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Mary Gertrude Barnes | Nurse Practitioner | Mangum City Hospital Authority | 1 Wickersham St, Mangum, OK 73554-9117 |
| David W Arles | Nurse Practitioner | Mangum City Hospital Authority | 1 Wickersham St, Mangum, OK 73554-9117 |
| Steven R Winham | Orthopedic Surgery | Mangum City Hospital Authority | 1 Wickersham St, Mangum, OK 73554-9117 |
| Edwinna G Smith | Nurse Practitioner | Blackhawk Mangum LLC | 1 Wickersham St, Mangum, OK 73554-9117 |
| James L Johnson | Family Practice | Blackhawk Mangum LLC | 1 Wickersham St, Mangum, OK 73554-9117 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Randy E Benish | Physician Assistant | Mangum City Hospital Authority | 118 S Louis Tittle Ave, Mangum Clinic, Mangum, OK 73554-4441 |
| City | MANGUM |
| Zip Code | 73554 |
| Specialty | NURSE PRACTITIONER |
| City + Specialty | MANGUM + NURSE PRACTITIONER |
Please comment or provide details below to improve the information on Jennifer Zachary.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.