Provider Demographics
NPI:1932298403
Name:SEMMELMANN, AUTUMN (PAC)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:
Last Name:SEMMELMANN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HEREFORD
Mailing Address - State:TX
Mailing Address - Zip Code:79045-4201
Mailing Address - Country:US
Mailing Address - Phone:806-364-7688
Mailing Address - Fax:806-364-7694
Practice Address - Street 1:125 W PARK AVE
Practice Address - Street 2:
Practice Address - City:HEREFORD
Practice Address - State:TX
Practice Address - Zip Code:79045-4201
Practice Address - Country:US
Practice Address - Phone:806-364-7688
Practice Address - Fax:806-364-7694
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03488363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D9328Medicare PIN
Q10910Medicare UPIN
TX8L1990Medicare PIN