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NPI Code Detail

MEDICARE: AUTUMN DEMARIS RN

MEDICARE: AUTUMN DEMARIS RN
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
1363LA2100XAcute Care Nurse Practitioner1064819TX

General Provider Information

NPI Number : 1255159273
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUTUMN DEMARIS RN
Provider Business Mailing Address
First Line : 5851 LEGACY CIR STE 600
Second Line :
City : PLANO
State : TX
Zip : 75024-5969
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 900 8TH AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-3902
Country : US
Telephone Number : 203-200-0749
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2024
Last Update Date : 05/06/2026

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