Provider Demographics
NPI:1487326906
Name:MCKILLIP, AUTUMN JUNE (FNP)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:JUNE
Last Name:MCKILLIP
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 1:6560 US HIGHWAY 277
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:OK
Mailing Address - Zip Code:73538
Mailing Address - Country:US
Mailing Address - Phone:580-454-7699
Mailing Address - Fax:
Practice Address - Street 1:6560 US HIGHWAY 277
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:OK
Practice Address - Zip Code:73538
Practice Address - Country:US
Practice Address - Phone:580-454-7699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-03
Last Update Date:2021-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0134984163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice