Healthcare Provider Details

I. General information

NPI: 1265898803
Provider Name (Legal Business Name): AUTUMN JOYCE MSN, APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2016
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10306 217TH ST
QUEENS VILLAGE NY
11429-1131
US

IV. Provider business mailing address

10306 217TH ST
QUEENS VILLAGE NY
11429-1131
US

V. Phone/Fax

Practice location:
  • Phone: 917-804-6826
  • Fax:
Mailing address:
  • Phone: 917-617-4758
  • Fax: 718-217-3727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number408125
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number612704
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number612704
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: