Provider Demographics
NPI:1386204329
Name:LONGWORTH, AUTUMN SAMANTHA (CRNA)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:SAMANTHA
Last Name:LONGWORTH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:SAMANTHA
Other - Last Name:MESSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:DEPT 888618
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37995-0001
Mailing Address - Country:US
Mailing Address - Phone:423-915-9942
Mailing Address - Fax:
Practice Address - Street 1:273 WINE CIR
Practice Address - Street 2:
Practice Address - City:BLOUNTVILLE
Practice Address - State:TN
Practice Address - Zip Code:37617-4315
Practice Address - Country:US
Practice Address - Phone:423-416-1678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024177740367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered