Provider Demographics
NPI:1891672994
Name:SCOTT, AUTUMN DANIELLE
Entity type:Individual
Prefix:MRS
First Name:AUTUMN
Middle Name:DANIELLE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 STAGGS RD
Mailing Address - Street 2:
Mailing Address - City:ETHRIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:38456-5817
Mailing Address - Country:US
Mailing Address - Phone:931-477-6111
Mailing Address - Fax:
Practice Address - Street 1:152 STAGGS RD
Practice Address - Street 2:
Practice Address - City:ETHRIDGE
Practice Address - State:TN
Practice Address - Zip Code:38456-5817
Practice Address - Country:US
Practice Address - Phone:931-477-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program