Provider Demographics
NPI:1740877745
Name:WHITTEN, AUTUMN ANNE (PA-C)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:ANNE
Last Name:WHITTEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:ANNE
Other - Last Name:SCHADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1225 10TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-5205
Mailing Address - Country:US
Mailing Address - Phone:810-987-6200
Mailing Address - Fax:
Practice Address - Street 1:1225 10TH ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-5205
Practice Address - Country:US
Practice Address - Phone:810-987-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant