Provider Demographics
NPI:1093229395
Name:HEMBREE, AUTUMN R (NP)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:R
Last Name:HEMBREE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 COGGINS AVE
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-0000
Mailing Address - Country:US
Mailing Address - Phone:817-408-9770
Mailing Address - Fax:918-649-0067
Practice Address - Street 1:210 W ROBERT ST
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-2942
Practice Address - Country:US
Practice Address - Phone:918-649-0069
Practice Address - Fax:918-649-0067
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-22
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR099588207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine