Provider Demographics
NPI:1720430523
Name:YOST, AUTUM NICOLE (AA)
Entity Type:Individual
Prefix:
First Name:AUTUM
Middle Name:NICOLE
Last Name:YOST
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:AUTUM
Other - Middle Name:NICOLE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AA
Mailing Address - Street 1:PO BOX 248846
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73124-8846
Mailing Address - Country:US
Mailing Address - Phone:800-475-6236
Mailing Address - Fax:706-653-1162
Practice Address - Street 1:1000 N LEE AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1036
Practice Address - Country:US
Practice Address - Phone:405-272-9641
Practice Address - Fax:405-235-0738
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant