Basic Information
| Provider Information | |||||||||
| NPI: | 1669775771 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEYER | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | OLIVER | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1500 | ||||||||
| Address2: | |||||||||
| City: | OSAGE BEACH | ||||||||
| State: | MO | ||||||||
| PostalCode: | 650651500 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1930 N BUSINESS ROUTE 5 | ||||||||
| Address2: | UNIT 1A | ||||||||
| City: | CAMDENTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 650202659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5733465624 | ||||||||
| FaxNumber: | 5733461957 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2010 | ||||||||
| LastUpdateDate: | 10/05/2011 | ||||||||
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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 | 363LF0000X | 2011016046 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | 990053 | CO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 164026 | 01 | CO | ACTIVE REGISTERED NURSE | OTHER |