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AUTUM WADE
NPI 1063155364
Peer Specialist in Johnson City, TN

Active since April 15, 2022
102 N BROADWAY ST, JOHNSON CITY, TN 37601(423) 588-9988 Get Directions Write a Review

NPPES record last updated: April 15, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Autum Wade NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

AUTUM WADE (NPI 1063155364) is an individual peer specialist in Johnson City, Tennessee, licensed in Tennessee (000-1410) and active in the NPI registry since April 2022.

NPPES Registry Identity

NPI1063155364
Entity TypeIndividualFemale
Primary Taxonomy175T00000X
Provider Legal NameAUTUM WADE
Location Address102 N BROADWAY STJohnson City, TN 37601-3525
Mailing Address102 N Broadway StJohnson City, TN 37601-3525
Phone(423) 588-9988
Sole ProprietorNo
Enumeration DateApril 15, 2022
NPPES CertifiedApril 15, 2022
✔ NPI 1063155364 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPeer SpecialistOther Service Providers
Taxonomy Code175T00000X
License✔ Licensed in TN · 000-1410
Definition
Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
102 N BROADWAY ST, Johnson City, TN 37601
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Other Providers at the Same Location NPPES 12

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

AUDRA OWENS LPN
Licensed Practical Nurse
102 N BROADWAY ST
JOHNSON CITY, TN 37601
Washington County (423) 588-9978
MRS. KRYSTAL STARR MERZ LPN
Licensed Practical Nurse
102 N BROADWAY ST
JOHNSON CITY, TN 37601
Washington County (423) 588-9978
DRAGFONFLY WELLNESS CENTER
Clinic/Center (Rehabilitation, Substance Use Disorder)
102 N BROADWAY ST
JOHNSON CITY, TN 37601
Washington County (423) 588-9978
MS. MARNICHELLE KY BONOCAN CLAMOHOY RN
Registered Nurse
102 N BROADWAY ST
JOHNSON CITY, TN 37601
Washington County (423) 588-9978
LINDSAY HOPE SMITH
Social Worker (Clinical)
102 N BROADWAY ST
JOHNSON CITY, TN 37601
Washington County (423) 588-9978
JACOB ELIZABETH PHILLIPS BSW
Social Worker
102 N BROADWAY ST
JOHNSON CITY, TN 37601
Washington County (423) 588-9978
DR. MATTHEW JOHN CAFFREY MD/MPH
Family Medicine (Addiction Medicine)
102 N BROADWAY ST
JOHNSON CITY, TN 37601
Washington County (423) 588-9978
DRAGONFLY MEDICAL AND BEHAVIORAL HEALTH PROFESSSIONAL CORPORATION
Family Medicine (Addiction Medicine)
102 N BROADWAY ST
JOHNSON CITY, TN 37601
Washington County (423) 588-9978

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Autum Wade's NPI number?

The NPI number for Autum Wade is 1063155364. It was assigned to this individual provider in the NPPES registry on April 15, 2022.

Where is Autum Wade located?

Autum Wade practices at 102 N Broadway St, Johnson City, TN 37601. The listed phone number is (423) 588-9988.

What is Autum Wade's specialty?

The primary specialty registered for this NPI is Peer Specialist with taxonomy code 175T00000X.

When was this NPI record last updated?

The NPPES record for Autum Wade was last updated on April 15, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.