Provider Demographics
NPI:1639488067
Name:HULTZ, AUTUMN M (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AUTUMN
Middle Name:M
Last Name:HULTZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 2ND ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:15438-1033
Mailing Address - Country:US
Mailing Address - Phone:724-797-3374
Mailing Address - Fax:
Practice Address - Street 1:1109 2ND ST
Practice Address - Street 2:
Practice Address - City:FAYETTE CITY
Practice Address - State:PA
Practice Address - Zip Code:15438-1033
Practice Address - Country:US
Practice Address - Phone:724-797-3374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054618363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical