Healthcare Provider Details

I. General information

NPI: 1063605228
Provider Name (Legal Business Name): AUTUMN MARIE STARNES D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AUTUMN MARIE STARNES D.O.

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 11/27/2025
Certification Date: 11/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 WOODLAND DR SW
WISE VA
24293-4623
US

IV. Provider business mailing address

5542 BURWELL RD
WISE VA
24293-5929
US

V. Phone/Fax

Practice location:
  • Phone: 276-365-8071
  • Fax: 276-221-1529
Mailing address:
  • Phone: 276-220-9149
  • Fax: 276-221-1529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0102202850
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: