Healthcare Provider Details

I. General information

NPI: 1174395446
Provider Name (Legal Business Name): AUTUMN HYATT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AUTUMN MARIE HYATT CRNP

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 AL HIGHWAY 157 STE B
CULLMAN AL
35058-1862
US

IV. Provider business mailing address

1935 AL HIGHWAY 157 STE B
CULLMAN AL
35058-1862
US

V. Phone/Fax

Practice location:
  • Phone: 256-530-4504
  • Fax: 256-542-9797
Mailing address:
  • Phone: 205-530-4504
  • Fax: 256-542-9797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1-180144
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: