Healthcare Provider Details

I. General information

NPI: 1548418114
Provider Name (Legal Business Name): ROBIN MICHELLE DECASTRO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2008
Last Update Date: 09/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 WILKINS CIRCLE
CASPER WY
82601-1336
US

IV. Provider business mailing address

992 E 121ST PL
OLATHE KS
66061-6760
US

V. Phone/Fax

Practice location:
  • Phone: 307-235-9583
  • Fax: 307-265-7277
Mailing address:
  • Phone: 307-259-3467
  • Fax: 913-273-1747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number18154.0972
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number53-76831-101
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: