Provider Demographics
NPI:1669981148
Name:MERCER, AUTUMN DAWN (FNP)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:DAWN
Last Name:MERCER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 BENNETT AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-6715
Mailing Address - Country:US
Mailing Address - Phone:541-779-5228
Mailing Address - Fax:541-772-1533
Practice Address - Street 1:825 BENNETT AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6715
Practice Address - Country:US
Practice Address - Phone:541-779-5228
Practice Address - Fax:541-772-1533
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201707776NP-PP363LG0600X
OR202002027NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500733407Medicaid