Provider Demographics
NPI:1316613417
Name:MORALES, AUTUMN DAWN (FNP-BC)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:DAWN
Last Name:MORALES
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:DAWN
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:503 E COLLIN RAYE DR
Mailing Address - Street 2:
Mailing Address - City:DE QUEEN
Mailing Address - State:AR
Mailing Address - Zip Code:71832-8048
Mailing Address - Country:US
Mailing Address - Phone:870-584-1053
Mailing Address - Fax:870-584-1094
Practice Address - Street 1:503 E COLLIN RAYE DR
Practice Address - Street 2:
Practice Address - City:DE QUEEN
Practice Address - State:AR
Practice Address - Zip Code:71832-8048
Practice Address - Country:US
Practice Address - Phone:870-557-7362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR216531363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty