Provider Demographics
NPI:1083470942
Name:CARLSON, ROBIN (CHW)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COURTLAND
Mailing Address - State:KS
Mailing Address - Zip Code:66939-3024
Mailing Address - Country:US
Mailing Address - Phone:785-955-0670
Mailing Address - Fax:785-335-4166
Practice Address - Street 1:314 MAIN ST
Practice Address - Street 2:
Practice Address - City:COURTLAND
Practice Address - State:KS
Practice Address - Zip Code:66939-3024
Practice Address - Country:US
Practice Address - Phone:785-955-0670
Practice Address - Fax:785-335-4166
Is Sole Proprietor?:No
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS240030172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSA-079-005OtherSTATE HOME HEALTHLICENSE