Provider Demographics
NPI:1235439183
Name:TRIPLETT, AUTUMN L (APRN)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:L
Last Name:TRIPLETT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 DERRICK PL
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-1325
Mailing Address - Country:US
Mailing Address - Phone:270-874-2629
Mailing Address - Fax:270-874-2774
Practice Address - Street 1:111 DERRICK PL
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-1325
Practice Address - Country:US
Practice Address - Phone:270-874-2629
Practice Address - Fax:270-874-2774
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006681363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00915985OtherRR MEDICARE
KY000000690860OtherANTHEM
KY7100141610Medicaid
KYP400039403Medicare PIN
KY000000690860OtherANTHEM
KYP400034351Medicare PIN
KYP400033807Medicare PIN
KYP400039404Medicare PIN