Provider Demographics
NPI:1821873746
Name:MYERS, ROBERT (FNP-C)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:MYERS
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24978 MS HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:MATHISTON
Mailing Address - State:MS
Mailing Address - Zip Code:39752-9220
Mailing Address - Country:US
Mailing Address - Phone:662-662-3089
Mailing Address - Fax:
Practice Address - Street 1:24978 MS HIGHWAY
Practice Address - Street 2:
Practice Address - City:MATHISTON
Practice Address - State:MS
Practice Address - Zip Code:39752-9220
Practice Address - Country:US
Practice Address - Phone:662-662-3089
Practice Address - Fax:662-634-3063
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSF07230167363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSLICENSEOther90622