Individual
MR. ZACHARY BLAKE FUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSN, APRN, PMHNP-BC
Contact information
Practice address
1220 PIERREMONT RD STE B, SHREVEPORT, LA 71106-1943
(318) 629-5036
Mailing address
6134 LOVERS LN, SHREVEPORT, LA 71105-4830
(318) 840-2616
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
202773
LA
Other
Enumeration date
09/12/2022
Last updated
09/12/2022
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