Healthcare Provider Details

I. General information

NPI: 1053560557
Provider Name (Legal Business Name): ROBIN K. CARLEY-WILLIAMSON PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 S CLARK AVE
LYONS KS
67554-3003
US

IV. Provider business mailing address

619 S CLARK AVE
LYONS KS
67554-3003
US

V. Phone/Fax

Practice location:
  • Phone: 620-257-5173
  • Fax: 620-257-2608
Mailing address:
  • Phone: 620-257-5173
  • Fax: 620-257-2608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMED-PAC-LIC-625
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA31125948
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15-01262
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: