Provider Demographics
NPI:1780488064
Name:CARPENTER, AUTUMN BROOKE (PA)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:BROOKE
Last Name:CARPENTER
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 W LOUIS HENNA BLVD
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-2300
Mailing Address - Country:US
Mailing Address - Phone:512-561-8800
Mailing Address - Fax:
Practice Address - Street 1:1220 W LOUIS HENNA BLVD
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-2300
Practice Address - Country:US
Practice Address - Phone:512-516-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant