Individual
AUTUMN K ONKST
Active
Individual
AUTUMN K ONKST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
PA790
KY
363AS0400X
Surgical Physician Assistant
Primary
PA790
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000377925
ANTHEM
KY
01
—
030670000
BLACK LUNG
KY
01
—
50005325
PASSPORT HEALTH PLAN
KY
01
—
61-1427889
CHA
KY
05
—
95005088
—
KY
01
—
C60877
CUMBERLAND HEALTHCARE INC
KY
Enumeration date
01/29/2007
Last updated
08/12/2011
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