Provider Demographics
NPI:1962445080
Name:HOPKINS, AUTUMN NICOLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AUTUMN
Middle Name:NICOLE
Last Name:HOPKINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:AUTUMN
Other - Middle Name:NICOLE
Other - Last Name:TRAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:311 E ALCOTT ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-6169
Mailing Address - Country:US
Mailing Address - Phone:269-373-5200
Mailing Address - Fax:
Practice Address - Street 1:311 E ALCOTT ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-6169
Practice Address - Country:US
Practice Address - Phone:269-373-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
MI5601004117363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N82780005Medicare ID - Type Unspecified
MIP98440Medicare UPIN