Provider Demographics
NPI:1417843020
Name:PHILLIPS, AUTUMN TERRY (APRN)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:TERRY
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 SHADYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-2480
Mailing Address - Country:US
Mailing Address - Phone:843-870-2048
Mailing Address - Fax:
Practice Address - Street 1:8595 PELHAM RD STE 400
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-5763
Practice Address - Country:US
Practice Address - Phone:864-316-8984
Practice Address - Fax:877-337-6283
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29967363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner