Provider Demographics
NPI:1437823242
Name:PRESCOTT, AUTUMN BROOKE (CNP-PC)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:BROOKE
Last Name:PRESCOTT
Suffix:
Gender:F
Credentials:CNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12178 CHESHIRE CT
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:VA
Mailing Address - Zip Code:20136-2409
Mailing Address - Country:US
Mailing Address - Phone:804-314-5441
Mailing Address - Fax:
Practice Address - Street 1:3914 CENTREVILLE RD STE 101
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-3289
Practice Address - Country:US
Practice Address - Phone:703-481-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024182289363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics