Healthcare Provider Details

I. General information

NPI: 1174893614
Provider Name (Legal Business Name): AUTUMN P. BARRETT PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2011
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 W 5TH ST STE 112
SHERIDAN WY
82801-2752
US

IV. Provider business mailing address

1333 W 5TH ST STE 110
SHERIDAN WY
82801-2752
US

V. Phone/Fax

Practice location:
  • Phone: 307-675-2650
  • Fax: 307-675-2651
Mailing address:
  • Phone: 307-675-2650
  • Fax: 307-675-2651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number538
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: