Provider Demographics
NPI:1043793854
Name:MARCY, AUTUMN LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:LYNN
Last Name:MARCY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:LYNN
Other - Last Name:CUNNINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:79 WAGNER RD STE 204
Mailing Address - Street 2:
Mailing Address - City:MONACA
Mailing Address - State:PA
Mailing Address - Zip Code:15061-2338
Mailing Address - Country:US
Mailing Address - Phone:724-773-1926
Mailing Address - Fax:878-439-3592
Practice Address - Street 1:79 WAGNER RD STE 204
Practice Address - Street 2:
Practice Address - City:MONACA
Practice Address - State:PA
Practice Address - Zip Code:15061-2338
Practice Address - Country:US
Practice Address - Phone:724-773-1926
Practice Address - Fax:878-439-3592
Is Sole Proprietor?:No
Enumeration Date:2018-09-09
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA065512363AM0700X, 363AM0700X
NY022438363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05429483Medicaid