NPI 1063155364

Autum Wade

Practitioner Peer Specialist Johnson City, TN

Practice location

Address: 102 N Broadway St, Johnson City, TN 37601-3525
Phone: (423) 588-9988

Registered specialties

Peer Specialist Primary

Other Service Providers Taxonomy 175T00000X Licence 000-1410 (TN)

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Registry record

NPI: 1063155364
Entity type: Individual
Sex (as registered): Female
NPI issued: 15 Apr 2022
Record last updated: 15 Apr 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.