Provider Demographics
NPI:1760050132
Name:WHITE, AUTUMN LYNN (FNP-C)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:LYNN
Last Name:WHITE
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 1:2280 HIGHWAY 63
Mailing Address - Street 2:
Mailing Address - City:RISON
Mailing Address - State:AR
Mailing Address - Zip Code:71665-8992
Mailing Address - Country:US
Mailing Address - Phone:870-723-2338
Mailing Address - Fax:
Practice Address - Street 1:7245 SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:WHITE HALL
Practice Address - State:AR
Practice Address - Zip Code:71602-3214
Practice Address - Country:US
Practice Address - Phone:870-850-8055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR216257363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily