Provider Demographics
NPI:1093269623
Name:MORRISON, ROBYN (PA-C)
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:
Last Name:MORRISON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5840 E 2ND ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-4363
Mailing Address - Country:US
Mailing Address - Phone:307-315-6133
Mailing Address - Fax:307-315-6134
Practice Address - Street 1:5840 E 2ND ST STE 200
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-4363
Practice Address - Country:US
Practice Address - Phone:307-315-6133
Practice Address - Fax:307-315-6134
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA0004732363A00000X
WYPA835363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY154148000Medicaid
CO31675042Medicaid