Provider Demographics
NPI:1356386361
Name:METSKER, RICHARD A (NP)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:METSKER
Suffix:
Gender:M
Credentials:NP
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 3810
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-3810
Mailing Address - Country:US
Mailing Address - Phone:417-782-3000
Mailing Address - Fax:417-782-3088
Practice Address - Street 1:1102 W 32ND ST
Practice Address - Street 2:SUITE 200
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3503
Practice Address - Country:US
Practice Address - Phone:417-782-3000
Practice Address - Fax:417-782-3088
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO107298363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO424843118Medicaid
S62895Medicare UPIN
MO820394074Medicare ID - Type Unspecified