Basic Information
| Provider Information | |||||||||
| NPI: | 1285610196 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARKER | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 513 E CAPITOL AVE | ||||||||
| Address2: | |||||||||
| City: | JEFFERSON CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 651013007 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1905 STADIUM BLVD | ||||||||
| Address2: | |||||||||
| City: | JEFFERSON CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 651091961 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736343000 | ||||||||
| FaxNumber: | 5736344010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 2001018095 | MO | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.