Provider Demographics
NPI:1134493125
Name:FEAZELL, AUTUMN L (FNP-BC)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:L
Last Name:FEAZELL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:LEIGH
Other - Last Name:CHENOWETH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:320 JONES AVE
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-2909
Mailing Address - Country:US
Mailing Address - Phone:304-465-2500
Mailing Address - Fax:304-465-2006
Practice Address - Street 1:320 JONES AVE
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901-2909
Practice Address - Country:US
Practice Address - Phone:304-465-2500
Practice Address - Fax:304-465-2006
Is Sole Proprietor?:No
Enumeration Date:2012-03-08
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV61562363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810023039Medicaid
WVWV1353BMedicare PIN