Provider Demographics
NPI:1043679970
Name:ROBISON, KAYLLA (LPN)
Entity Type:Individual
Prefix:
First Name:KAYLLA
Middle Name:
Last Name:ROBISON
Suffix:
Gender:F
Credentials:LPN
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 1005
Mailing Address - Street 2:
Mailing Address - City:BUCKLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98321-1005
Mailing Address - Country:US
Mailing Address - Phone:253-740-6547
Mailing Address - Fax:
Practice Address - Street 1:4012 WIGGINS RD SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-4372
Practice Address - Country:US
Practice Address - Phone:360-491-1036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-20
Last Update Date:2016-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60546696164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse