Provider Demographics
NPI:1144715269
Name:PAUL, ZACHARY YANCEY (FP-C)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:YANCEY
Last Name:PAUL
Suffix:
Gender:M
Credentials:FP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 402
Mailing Address - Street 2:
Mailing Address - City:DE LEON
Mailing Address - State:TX
Mailing Address - Zip Code:76444-0402
Mailing Address - Country:US
Mailing Address - Phone:817-734-5393
Mailing Address - Fax:
Practice Address - Street 1:1716 HAL AVE
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76031-7614
Practice Address - Country:US
Practice Address - Phone:817-487-9143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-30
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX170398146L00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic