Provider Demographics
NPI:1407015308
Name:YETKA, ROBYN CARROLL (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ROBYN
Middle Name:CARROLL
Last Name:YETKA
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 1:714 W FOX FARM RD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82007-2360
Mailing Address - Country:US
Mailing Address - Phone:130-777-8783
Mailing Address - Fax:130-777-8257
Practice Address - Street 1:714 W FOX FARM RD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82007-2360
Practice Address - Country:US
Practice Address - Phone:130-777-8783
Practice Address - Fax:130-777-8257
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY118363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY54RCY07MOtherWYOMING CONTROLLED SUBSTANCE
WY118OtherWYOMING BOARD OF MEDICINE
WY118OtherWYOMING BOARD OF MEDICINE