Provider Demographics
NPI:1235719394
Name:BENSON, AUTUMN SAGE
Entity type:Individual
Prefix:MRS
First Name:AUTUMN
Middle Name:SAGE
Last Name:BENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:
Other - Last Name:YODER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:275 NEWBERRY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MEAD
Mailing Address - State:OK
Mailing Address - Zip Code:73449-6458
Mailing Address - Country:US
Mailing Address - Phone:814-483-1212
Mailing Address - Fax:
Practice Address - Street 1:275 NEWBERRY CREEK RD
Practice Address - Street 2:
Practice Address - City:MEAD
Practice Address - State:OK
Practice Address - Zip Code:73449-6458
Practice Address - Country:US
Practice Address - Phone:814-483-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2025-09-24
Deactivation Date:2025-05-17
Deactivation Code:
Reactivation Date:2025-09-19
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No171400000XOther Service ProvidersHealth & Wellness Coach