MEDICARE: AUTUMN RENEE APGAR MS, PA-C

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	363A00000X	Physician Assistant	PA1435	NV
2	363A00000X	Physician Assistant	PA21805	CA

General Provider Information

NPI Number	:	1902181381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUTUMN RENEE APGAR MS, PA-C

Provider Business Mailing Address
First Line	:	2433 MARCONI AVE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95821-4807
Country	:	US
Telephone Number	:	916-737-5555
Fax Number	:

Provider Business Practice Location Address
First Line	:	2433 MARCONI AVE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95821-4807
Country	:	US
Telephone Number	:	916-737-5555
Fax Number	:

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

Provider Enumeration Date	:	10/17/2011
Last Update Date	:	10/12/2022

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