Provider Demographics
NPI:1366925893
Name:RAFFORD, AUTUMN DANIELLE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:AUTUMN
Middle Name:DANIELLE
Last Name:RAFFORD
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 1:123 BEAR BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:KATHLEEN
Mailing Address - State:GA
Mailing Address - Zip Code:31047-2404
Mailing Address - Country:US
Mailing Address - Phone:678-371-2798
Mailing Address - Fax:
Practice Address - Street 1:123 BEAR BRANCH RD
Practice Address - Street 2:
Practice Address - City:KATHLEEN
Practice Address - State:GA
Practice Address - Zip Code:31047-2404
Practice Address - Country:US
Practice Address - Phone:678-371-2798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN211585363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily