DR. AUTUM LYNN DESOTO (NPI# 1730404872) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730404872 |
| Entity Type | Individual |
| Full Name | DR. AUTUM LYNN DESOTO |
| Credential | MD |
| Practice Address |
4102 24th St Suite 507 Lubbock TX 79410-1806 |
| Mailing Address |
3420 22nd Pl Lubbock TX 79410-1314 |
| Practice Telephone | 8067257750 |
| Practice Fax Number | 8067237518 |
| Mailing Telephone | 8067255844 |
| Mailing Fax Number | 8067236532 |
| Enumeration Date | 2010-04-01 |
| Last Update Date | 2013-08-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | P6374 | TX | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Street Address |
4102 24TH ST SUITE 507 |
| City | LUBBOCK |
| State | TX |
| Zip Code | 79410-1806 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700880382 | Barbara Haight Way | Specialist | 4102 24th St, Ste 201, Lubbock, TX 79410-1801 | 2005-06-10 |
| 1902318736 | Olivia A Harris | Nurse Practitioner | 4102 24th St, Lubbock, TX 79410 | 2017-11-02 |
| 1407131246 | Vivian Vanessa Cox | Nurse Practitioner | 4102 24th St, Ste. 303, Lubbock, TX 79410-1806 | 2011-10-12 |
| 1275721045 | Terry Gage, Md | Family Medicine | 4102 24th St, Suite 404, Lubbock, TX 79410-1806 | 2007-10-05 |
| 1578754149 | Carol Tracy Suit | Obstetrics & Gynecology | 4102 24th St, Suite 300, Lubbock, TX 79410-1806 | 2007-08-07 |
| 1144411711 | Amanda Beth Hatton | Obstetrics & Gynecology | 4102 24th St, Suite 300, Lubbock, TX 79410-1806 | 2007-08-07 |
| 1780788067 | Kevin Clark Worley | Obstetrics & Gynecology | 4102 24th St, 101, Lubbock, TX 79410-1806 | 2006-09-08 |
| 1801906656 | James Terry Gage | Family Medicine | 4102 24th St, Suite 404, Lubbock, TX 79410-1804 | 2006-08-30 |
| 1225046956 | John Halsey Pharmacy | Pharmacy | 4102 24th St, Ste 103, Lubbock, TX 79410-1806 | 2006-08-05 |
| 1346274610 | Mark Allen Feist | Pediatrics | 4102 24th St, Suite 401, Lubbock, TX 79410-1806 | 2006-07-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548878267 | Covenant Medical Center | Clinic/Center | 3615 19th, Lifestyle Centre-east Parking Garage, Lubbock, TX 79410 | 2020-07-20 |
| 1669038626 | Hub City Anesthesia | Nurse Anesthetist, Certified Registered | 3416 22nd Street, Lubbock, TX 79410 | 2019-05-15 |
| 1912447418 | Lubbock Surgery Center, LLC | Clinic/Center | 3416 22nd St, Lubbock, TX 79410 | 2017-03-02 |
| 1871032698 | Lezlee Berry | Pharmacist | 3615 19th Street, Lubbock, TX 79410 | 2017-02-13 |
| 1376914101 | Matthew Cotton | Nurse Practitioner | 2424 Quaker Ave, Lubbock, TX 79410 | 2015-10-20 |
| 1841534864 | Frank Nwabugwu | Pharmacist | 4120 34th Street, Lubbock, TX 79410 | 2012-11-15 |
| 1689954794 | Dharmendra Kumar | Pediatrics | Covenant Children's Hospital, 4000 24th Street, Lubbock, TX 79410 | 2011-08-19 |
| 1518277177 | T.r.m. Rao, M.d., P.a. | Colon & Rectal Surgery | 3809 22nd Street, Suite C, Lubbock, TX 79410 | 2010-10-18 |
| 1700196672 | Hanford Consultations P.a. | Family Medicine | 4000 22nd Place Suite 100, Lubbock, TX 79410 | 2010-10-13 |
| 1336452598 | Amanda Collins | Specialist | 4801 34th Street, Lubbock, TX 79410 | 2010-07-16 |
| Find all providers in zip 79410 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689188484 | Sarada Devi Narendran | Pediatrics | 9313 Salisbury Ave, Lubbock, TX 79424-5023 | 2017-12-01 |
| 1104237015 | Coby Robins | Pediatrics | Ttuhsc, Department of Pediatrics, Lubbock, TX 79430-0002 | 2014-05-13 |
| 1801227483 | Glenn Joseph Boris | Pediatrics | 3204 44th St, Lubbock, TX 79413-3506 | 2013-12-06 |
| 1508122110 | Mirla L Avila | Pediatrics | 3601 4th Street, Ms 8321, Dept. of Neurology, Lubbock, TX 79430 | 2012-04-09 |
| 1437435856 | West Texas Kid's Clinic, Pllc | Pediatrics | 5004 Frankford Ave Unit 400, Lubbock, TX 79424-1138 | 2011-10-31 |
| 1477864130 | Rebekah Grace Phillips | Pediatrics | 3601 4th St Stop 9406, Department of Pediatrics Ttuhsc, Lubbock, TX 79430-0002 | 2010-06-28 |
| 1013243278 | Jane Elizabeth Wheeler | Pediatrics | 4617 92nd St, Lubbock, TX 79424-5033 | 2009-10-22 |
| 1861636862 | Celeste Xochitl Twelves Caballero | Pediatrics | 5202 82nd St, Lubbock, TX 79424-2823 | 2009-04-22 |
| 1578713244 | Jeremy Robert Dalton | Pediatrics | 4102 24th St Ste 103, Lubbock, TX 79410-1800 | 2008-09-30 |
| 1306016019 | Maurice Asmussen | Pediatrics | 1313 Broadway Ste 5, Lubbock, TX 79401-3209 | 2008-03-10 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.