Provider Demographics
NPI:1982087631
Name:SPELLMEIER, AUTUMN JADE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:AUTUMN
Middle Name:JADE
Last Name:SPELLMEIER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:JADE
Other - Last Name:MOSIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:106 WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:GOODLAND
Mailing Address - State:KS
Mailing Address - Zip Code:67735-1518
Mailing Address - Country:US
Mailing Address - Phone:785-890-4012
Mailing Address - Fax:785-890-6077
Practice Address - Street 1:106 WILLOW RD
Practice Address - Street 2:
Practice Address - City:GOODLAND
Practice Address - State:KS
Practice Address - Zip Code:67735-1518
Practice Address - Country:US
Practice Address - Phone:785-890-6075
Practice Address - Fax:785-890-6077
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-76843-091363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201118440AMedicaid
KS1982087631OtherBCBS
KS111003017Medicare PIN