Individual
JEFFREY WAYNE AUTRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
1004 BEAMON ST., CLINTON, NC 28328-0227
(910) 592-9113
(910) 590-0050
Mailing address
1004 BEAMON ST., CLINTON, NC 28328-0227
(910) 592-9113
(910) 590-0050
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
105149
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2344540
MEDICARE GROUP NO
NC
01
—
2806457A
MEDICARE INDIV PROVIDER
NC
Enumeration date
04/03/2006
Last updated
11/21/2007
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