Provider Demographics
NPI:1386025138
Name:HARKREADER, BRUCE FERRELL (CPC- INTERN)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:FERRELL
Last Name:HARKREADER
Suffix:
Gender:M
Credentials:CPC- INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1842
Mailing Address - Street 2:
Mailing Address - City:LOVELOCK
Mailing Address - State:NV
Mailing Address - Zip Code:89419-1842
Mailing Address - Country:US
Mailing Address - Phone:775-442-0663
Mailing Address - Fax:
Practice Address - Street 1:13005 DEER LAKE TR.
Practice Address - Street 2:
Practice Address - City:LOVELOCK
Practice Address - State:NV
Practice Address - Zip Code:89419
Practice Address - Country:US
Practice Address - Phone:775-273-2002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCI0395101YM0800X
NVCI0336101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health