# MISTY AUTUMN MCGILLEM

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1467847822
- **Gender:** F
- **Credential:** DNP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163W00000X | Registered Nurse | RN 175929 | AZ | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | AP9889 | AZ | Yes |

## Other

- **Enumeration date:** 04/02/2015
- **Last updated:** 07/21/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 235041 | — | AZ |