Provider Demographics
NPI:1053560557
Name:CARLEY-WILLIAMSON, ROBIN K (PAC)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:K
Last Name:CARLEY-WILLIAMSON
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 S CLARK AVE
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:KS
Mailing Address - Zip Code:67554-3003
Mailing Address - Country:US
Mailing Address - Phone:620-257-5173
Mailing Address - Fax:620-257-2608
Practice Address - Street 1:619 S CLARK AVE
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:KS
Practice Address - Zip Code:67554-3003
Practice Address - Country:US
Practice Address - Phone:620-257-5173
Practice Address - Fax:620-257-2608
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-PAC-LIC-625363A00000X
WAPA31125948363A00000X
KS15-01262363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200578630AMedicaid
KS13-41767-112OtherREGISTERED NURSE LICENSE
KS15-01262OtherPA LICENSE
WA217086Medicaid
MTMED-PAC-LIC-625OtherMONTANA PHYSICIAN ASSISTANT LICENSE
KS200578630AMedicaid