# AUTUMN D MERCER AGNP-C LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790241065
- **Authorized official:** AUTUMN DAWN MERCER (PROVIDER)
- **Authorized official phone:** (503) 309-8026

## Contact information

- **Practice address:** 620 N 5TH ST, JACKSONVILLE, OR 97530-9659
- **Practice address phone:** (503) 309-8026
- **Practice address fax:** (541) 291-9819
- **Mailing address:** 620 N 5TH ST, JACKSONVILLE, OR 97530-9659
- **Mailing address phone:** (503) 309-8026
- **Mailing address fax:** (541) 291-9819

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LA2200X | Adult Health Nurse Practitioner | — | NULL | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 02/12/2019
- **Last updated:** 10/24/2023