Provider Demographics
NPI:1548418114
Name:DECASTRO, ROBIN MICHELLE (APRN)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:MICHELLE
Last Name:DECASTRO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:992 E 121ST PL
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-6760
Mailing Address - Country:US
Mailing Address - Phone:307-259-3467
Mailing Address - Fax:913-273-1747
Practice Address - Street 1:1430 WILKINS CIRCLE
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-1336
Practice Address - Country:US
Practice Address - Phone:307-235-9583
Practice Address - Fax:307-265-7277
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY18154.0972363LP0808X
KS53-76831-101363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS53-76831-101OtherAPRN LICENSE
WY941OtherTEMPORARY GRADUATE APRN LICENSE
WY18154.0972OtherAPRN WITH PRESCRIPTIVE AUTHORITY