Provider Demographics
NPI:1164276267
Name:THOMPSON, AUTUMN (CERTIFIED NURSE ASSI)
Entity Type:Individual
Prefix:MS
First Name:AUTUMN
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CERTIFIED NURSE ASSI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 N HIGHLAND ST APT 105
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-2198
Mailing Address - Country:US
Mailing Address - Phone:704-923-5099
Mailing Address - Fax:
Practice Address - Street 1:401 N HIGHLAND ST APT 105
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-2198
Practice Address - Country:US
Practice Address - Phone:704-923-5099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
347C00000X, 372600000X, 3747P1801X
NC544849376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No347C00000XTransportation ServicesPrivate Vehicle
No372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant