Provider Demographics
NPI:1043683527
Name:LUCAS, AUTUMN ANDERSON (FNP)
Entity type:Individual
Prefix:MRS
First Name:AUTUMN
Middle Name:ANDERSON
Last Name:LUCAS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 HINES TER
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-2818
Mailing Address - Country:US
Mailing Address - Phone:478-955-4899
Mailing Address - Fax:
Practice Address - Street 1:100 UNIVERSITY PARKWAY
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31206
Practice Address - Country:US
Practice Address - Phone:478-471-2092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-05
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN190806363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily