Healthcare Provider Details

I. General information

NPI: 1689528580
Provider Name (Legal Business Name): AUTUMN HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 S FRANKLIN ST APT 10E
TULLAHOMA TN
37388-4268
US

IV. Provider business mailing address

1015 S FRANKLIN ST APT 10E
TULLAHOMA TN
37388-4268
US

V. Phone/Fax

Practice location:
  • Phone: 931-269-9828
  • Fax:
Mailing address:
  • Phone: 931-269-9828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number41-4488496
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: