Basic Information
| Provider Information | |||||||||
| NPI: | 1598028698 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARKER | ||||||||
| FirstName: | NICKOLAS | ||||||||
| MiddleName: | GRANT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 51088 | ||||||||
| Address2: | |||||||||
| City: | CASPER | ||||||||
| State: | WY | ||||||||
| PostalCode: | 826051088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3072330246 | ||||||||
| FaxNumber: | 3072375421 | ||||||||
| Practice Location | |||||||||
| Address1: | 3632 AMERICAN WAY STE A | ||||||||
| Address2: | |||||||||
| City: | CASPER | ||||||||
| State: | WY | ||||||||
| PostalCode: | 826013164 | ||||||||
| CountryCode: | UM | ||||||||
| TelephoneNumber: | 3072346765 | ||||||||
| FaxNumber: | 3072346998 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2012 | ||||||||
| LastUpdateDate: | 01/25/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 9701A | WY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.