MEDICARE: AUTUMN SMITH CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	LE-00042708	OH
2	363LA2100X	Acute Care Nurse Practitioner	LE-00042708	OH

General Provider Information

NPI Number	:	1053027268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUTUMN SMITH CNP

Provider Business Mailing Address
First Line	:	2838 SECTION RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45237-3716
Country	:	US
Telephone Number	:	765-729-2639
Fax Number	:	513-475-8033

Provider Business Practice Location Address
First Line	:	3113 BELLEVUE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45219-3158
Country	:	US
Telephone Number	:	765-729-2639
Fax Number	:	513-475-8033

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2023
Last Update Date	:	11/08/2023

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