Healthcare Provider Details

I. General information

NPI: 1487326906
Provider Name (Legal Business Name): AUTUMN JUNE MCKILLIP FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2021
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BUILDING 684 WAIANAE AVENUE
SCHOFIELD BARRACKS HI
96786
US

IV. Provider business mailing address

BUILDING 684 WAIANAE AVENUE
SCHOFIELD BARRACKS HI
96786
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-8045
  • Fax:
Mailing address:
  • Phone: 808-433-8045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5586
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: