MEDICARE: AUTUMN STAPLETON APN

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	363LF0000X	Family Nurse Practitioner	106168	WV

General Provider Information

NPI Number	:	1194692079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUTUMN STAPLETON APN

Provider Business Mailing Address
First Line	:	1448 10TH AVE STE 304
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-3579
Country	:	US
Telephone Number	:	304-733-8728
Fax Number	:	304-691-8591

Provider Business Practice Location Address
First Line	:	1600 MEDICAL CENTER DR STE B500
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-3655
Country	:	US
Telephone Number	:	304-691-1787
Fax Number	:	304-691-8711

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

Provider Enumeration Date	:	10/23/2025
Last Update Date	:	12/15/2025

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Directions to “ AUTUMN STAPLETON APN” Practice Location

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