Provider Demographics
NPI:1215773494
Name:SHARP, AUTUMN WIND
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:WIND
Last Name:SHARP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1554 N PEARSON DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65802-9436
Mailing Address - Country:US
Mailing Address - Phone:417-763-5414
Mailing Address - Fax:
Practice Address - Street 1:4058 S LONE PINE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-6605
Practice Address - Country:US
Practice Address - Phone:417-763-5414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other