Healthcare Provider Details

I. General information

NPI: 1669775771
Provider Name (Legal Business Name): ROBERT OLIVER MEYER FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2010
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 N BUSINESS ROUTE 5 UNIT 1A
CAMDENTON MO
65020-2659
US

IV. Provider business mailing address

PO BOX 1500
OSAGE BEACH MO
65065-1500
US

V. Phone/Fax

Practice location:
  • Phone: 573-346-5624
  • Fax: 573-346-1957
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number990053
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2011016046
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: