Active NPI
Zachary Fetterman, PHD
- Clinical Psychologist
- Usaf Academy, CO
National Provider Identifier
1487052486
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 10404713-2501
- Practice address
- 10 Medical Group
4102 Pinion Drive
Usaf Academy, CO 80840 - Phone
- (719) 333-5177
- NPI assigned
- Dec 8, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 10404713-2501 | UT | Primary |
Addresses
Primary practice location
10 Medical Group
4102 Pinion Drive
Usaf Academy, CO 80840
Mailing address
10TH Medical Group
4102 Pinion Drive
Usaf Academy, CO 80840
Phone (179) 333-5177
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10404713-2501 | UT | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1417996800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1698796800000",
"number": "1487052486",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10TH MEDICAL GROUP",
"address_2": "4102 PINION DRIVE",
"city": "USAF ACADEMY",
"state": "CO",
"postal_code": "80840",
"telephone_number": "179-333-5177"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 MEDICAL GROUP",
"address_2": "4102 PINION DRIVE",
"city": "USAF ACADEMY",
"state": "CO",
"postal_code": "80840",
"telephone_number": "719-333-5177"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FETTERMAN",
"first_name": "ZACHARY",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-12-08",
"last_updated": "2023-11-01",
"certification_date": "2023-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "UT",
"license": "10404713-2501",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Usaf Academy, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.