Provider Demographics
NPI:1932824950
Name:ALLGOOD, AUTUMN LYNNETTE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:AUTUMN
Middle Name:LYNNETTE
Last Name:ALLGOOD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-2102
Mailing Address - Country:US
Mailing Address - Phone:573-717-1332
Mailing Address - Fax:
Practice Address - Street 1:500 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-2102
Practice Address - Country:US
Practice Address - Phone:573-717-1332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022040624363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily