Autumn Dawn Nettles, R.N.

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

RN.379485 Issued in OH

Practice address

104 N Michigan Ave
Wellston, OH 45692-1144

Phone

(740) 418-8420

NPI assigned

Nov 15, 2011

Last updated

Feb 9, 2017By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1321315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486598400000",
    "number": "1063799245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 N MICHIGAN AVE",
            "city": "WELLSTON",
            "state": "OH",
            "postal_code": "456921144",
            "telephone_number": "740-418-8420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 N MICHIGAN AVE",
            "city": "WELLSTON",
            "state": "OH",
            "postal_code": "456921144",
            "telephone_number": "740-418-8420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NETTLES",
        "first_name": "AUTUMN",
        "middle_name": "DAWN",
        "name_prefix": "Ms.",
        "credential": "R.N.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-11-15",
        "last_updated": "2017-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OH",
            "license": "RN.379485",
            "primary": true
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "OH",
            "license": "PN.118312-MEDS",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Registered Nurse in Wellston, OH
• Providers in Wellston, OH by specialty
• Registered Nurse in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.