Provider Demographics
NPI:1104517796
Name:MYER, JAROD (FNP-C)
Entity type:Individual
Prefix:
First Name:JAROD
Middle Name:
Last Name:MYER
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 1:30006 406TH AVE
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:SD
Mailing Address - Zip Code:57315-5404
Mailing Address - Country:US
Mailing Address - Phone:605-660-5996
Mailing Address - Fax:
Practice Address - Street 1:513 3RD ST SW
Practice Address - Street 2:
Practice Address - City:WAGNER
Practice Address - State:SD
Practice Address - Zip Code:57380-9675
Practice Address - Country:US
Practice Address - Phone:605-384-3611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP002793207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine