Provider Demographics
NPI:1144907155
Name:BURKMAN, AUTUMN (CNM)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:
Last Name:BURKMAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2715 N COUNTY ROAD 275 E
Mailing Address - Street 2:
Mailing Address - City:NORTH VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47265-9393
Mailing Address - Country:US
Mailing Address - Phone:812-764-5572
Mailing Address - Fax:
Practice Address - Street 1:2450 NORTHPARK DR STE A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-2292
Practice Address - Country:US
Practice Address - Phone:812-376-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-30
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71014122A363LW0102X
IN09000414A367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health