Basic Information
| Provider Information | |||||||||
| NPI: | 1548418114 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DECASTRO | ||||||||
| FirstName: | ROBIN | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 992 E 121ST PL | ||||||||
| Address2: | |||||||||
| City: | OLATHE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660616760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3072593467 | ||||||||
| FaxNumber: | 9132731747 | ||||||||
| Practice Location | |||||||||
| Address1: | 1430 WILKINS CIRCLE | ||||||||
| Address2: | |||||||||
| City: | CASPER | ||||||||
| State: | WY | ||||||||
| PostalCode: | 826011336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3072359583 | ||||||||
| FaxNumber: | 3072657277 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2008 | ||||||||
| LastUpdateDate: | 09/29/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 18154.0972 | WY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363LP0808X | 53-76831-101 | KS | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 53-76831-101 | 01 | KS | APRN LICENSE | OTHER | 941 | 01 | WY | TEMPORARY GRADUATE APRN LICENSE | OTHER | 18154.0972 | 01 | WY | APRN WITH PRESCRIPTIVE AUTHORITY | OTHER |