Provider Demographics
NPI:1831527191
Name:KONZ, AUTUMN KARI (PA-C, MPH)
Entity type:Individual
Prefix:MS
First Name:AUTUMN
Middle Name:KARI
Last Name:KONZ
Suffix:
Gender:F
Credentials:PA-C, MPH
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:K
Other - Last Name:FINGERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C, MPH
Mailing Address - Street 1:4220 N ROXBORO ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-1826
Mailing Address - Country:US
Mailing Address - Phone:865-599-1858
Mailing Address - Fax:919-668-5088
Practice Address - Street 1:4220 N ROXBORO ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-1826
Practice Address - Country:US
Practice Address - Phone:919-613-7848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-24
Last Update Date:2022-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA23245363A00000X
NC0010-6493363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant