MEDICARE: KRISTINE LIAZ OGLESBY CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife	19201	SC
2	176B00000X	Midwife	19201	SC
3	207VG0400X	Gynecology Physician	19201	SC

General Provider Information

NPI Number	:	1538550827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINE LIAZ OGLESBY CNM

Provider Business Mailing Address
First Line	:	300 E MCBEE AVE STE 400
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29601-2899
Country	:	US
Telephone Number	:	864-695-6697
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 MEDICAL PARK CT
Second Line	:
City	:	CLINTON
State	:	SC
Zip	:	29325-7537
Country	:	US
Telephone Number	:	864-358-7387
Fax Number	:	864-938-0229

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2015
Last Update Date	:	12/16/2025

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