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NPI Code Detail

MEDICARE: AUTUMN LEBAKKEN FNP-C

MEDICARE: AUTUMN LEBAKKEN FNP-C
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
1363L00000XNurse Practitioner1221569TX

General Provider Information

NPI Number : 1396677514
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUTUMN LEBAKKEN FNP-C
Provider Business Mailing Address
First Line : 1724 RICHMOND AVE
Second Line :
City : HOUSTON
State : TX
Zip : 77098-3604
Country : US
Telephone Number : 832-818-3900
Fax Number : 858-667-6635
Provider Business Practice Location Address
First Line : 1724 RICHMOND AVE
Second Line :
City : HOUSTON
State : TX
Zip : 77098-3604
Country : US
Telephone Number : 832-818-3900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2026
Last Update Date : 06/01/2026

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Directions to “ AUTUMN LEBAKKEN FNP-C” Practice Location

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