Provider Demographics
NPI:1144639170
Name:SHAW, AUTUM DAWN (MSN, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:AUTUM
Middle Name:DAWN
Last Name:SHAW
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2263 SANDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-2593
Mailing Address - Country:US
Mailing Address - Phone:423-353-1070
Mailing Address - Fax:
Practice Address - Street 1:2263 SANDSTONE DR
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-2593
Practice Address - Country:US
Practice Address - Phone:423-535-4544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000018876363L00000X, 363LF0000X
TN0000018876363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily