Individual
MRS. AUTUMN LYNN BERTHOLDI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3850 S NATIONAL AVE STE 705, SPRINGFIELD, MO 65807-5239
(417) 900-3407
(417) 889-0476
Mailing address
801 YORK ST, MANITOWOC, WI 54220-4630
(920) 663-9008
(920) 684-1439
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
2006010979
MO
363A00000X
Physician Assistant
Primary
2006010979
MO
Other
Enumeration date
06/26/2006
Last updated
02/26/2026
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