Basic Information
| Provider Information | |||||||||
| NPI: | 1033401252 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WARD | ||||||||
| FirstName: | ROBYN | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | P.A.-C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 W CANNON ST | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761043029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8178775858 | ||||||||
| FaxNumber: | 8173354418 | ||||||||
| Practice Location | |||||||||
| Address1: | 909 9TH AVE STE 400 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761043932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177257880 | ||||||||
| FaxNumber: | 8177257885 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2011 | ||||||||
| LastUpdateDate: | 09/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA05854 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 280871905 | 05 | TX | MEDICAID |