Provider Demographics
NPI:1811538218
Name:SCHNEIDER, AUTUMN BROOKE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:BROOKE
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 CLINIC DR STE A
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:KY
Mailing Address - Zip Code:40361-2166
Mailing Address - Country:US
Mailing Address - Phone:859-987-0302
Mailing Address - Fax:
Practice Address - Street 1:24 CLINIC DR STE A
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:KY
Practice Address - Zip Code:40361-2166
Practice Address - Country:US
Practice Address - Phone:859-987-0302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2022-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013923363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100630540Medicaid