Active NPI
Autumn Susan Trace, LPN
- Licensed Practical Nurse
- Jackson, OH
National Provider Identifier
1316084346
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- PN050719
- Practice address
- 710 Jackson Hill Rd
Jackson, OH 45640-9301 - Phone
- (740) 286-0212
- NPI assigned
- Jan 31, 2007
- Last updated
- Jul 9, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | PN050719 | OH | Primary |
Addresses
Primary practice location
710 Jackson Hill Rd
Jackson, OH 45640-9301
Mailing address
710 Jackson Hill Rd
Jackson, OH 45640-9301
Phone (740) 286-0212
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2578545 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PN050719 | OH | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1316084346",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "710 JACKSON HILL RD",
"city": "JACKSON",
"state": "OH",
"postal_code": "456409301",
"telephone_number": "740-286-0212"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "710 JACKSON HILL RD",
"city": "JACKSON",
"state": "OH",
"postal_code": "456409301",
"telephone_number": "740-286-0212"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRACE",
"first_name": "AUTUMN",
"middle_name": "SUSAN",
"name_prefix": "Mrs.",
"credential": "LPN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-31",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "OH",
"license": "PN050719",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2578545",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jackson, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.