Zachary Austin Kietzman, NP-C

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

12068 Issued in CT

Practice address

3 Farm Glen Blvd
Farmington, CT 06030-1285

Phone

(803) 629-4134

NPI assigned

Apr 17, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 6

Addresses

Other names 1

• Zachary Austin Hill Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Interoperability endpoints

• Direct secure messaging: ms_zkietzma@landmarkhealth-direct.org

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1587081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692489600000",
    "number": "1861012015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "87B OLIVE ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065116913",
            "telephone_number": "803-629-4134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 FARM GLEN BLVD",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060301285",
            "telephone_number": "803-629-4134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIETZMAN",
        "first_name": "ZACHARY",
        "middle_name": "AUSTIN",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-17",
        "last_updated": "2023-08-20",
        "certification_date": "2023-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CT",
            "license": "209707",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "GA",
            "license": "RN236642",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "GA",
            "license": "RN236642",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "CT",
            "license": "12068",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "GA",
            "license": "RN236642",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "CT",
            "license": "12068",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ZACHARY",
            "last_name": "HILL",
            "middle_name": "AUSTIN",
            "credential": "NP-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Namita Khandelwal, BDS, MS
• Nikita Khillon
• Sayeh Kia, PA-C
• Neiha Kidwai, DO
• Ruben Kier
• Carolyn Kilbride, D.M.D.
• Emily R Kilian
• Agnes Kim, M.D.
• Hyun a Kim, D.M.D.
• Jin Woo Kim, M.D.

• Primary Care Nurse Practitioner in Farmington, CT
• Providers in Farmington, CT by specialty
• Primary Care Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.