Provider Demographics
NPI:1922508506
Name:BROWN, AUTUMN LEIGH
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:LEIGH
Last Name:BROWN
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 1:1071 JOANNA DR
Mailing Address - Street 2:
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535-2718
Mailing Address - Country:US
Mailing Address - Phone:337-280-0453
Mailing Address - Fax:
Practice Address - Street 1:1071 JOANNA DR
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-2718
Practice Address - Country:US
Practice Address - Phone:337-280-0453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program