Provider Demographics
NPI:1053942482
Name:ROBESON, AUTUMN JOY (FNP)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:JOY
Last Name:ROBESON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8363 W MAYA DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-3824
Mailing Address - Country:US
Mailing Address - Phone:928-242-0683
Mailing Address - Fax:
Practice Address - Street 1:14000 N HAYDEN RD STE 180
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-5561
Practice Address - Country:US
Practice Address - Phone:480-347-3431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ235924207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ235924Medicaid