Provider Demographics
NPI:1306396809
Name:HALL, AUTUMN RHEA (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:AUTUMN
Middle Name:RHEA
Last Name:HALL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12732 BRECKENRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-2710
Mailing Address - Country:US
Mailing Address - Phone:817-681-2148
Mailing Address - Fax:
Practice Address - Street 1:980 N WALNUT CREEK DR STE 100
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-8020
Practice Address - Country:US
Practice Address - Phone:817-473-9473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132141363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily