MEDICARE: AMBER LOVE LATHAM FNP-BC

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	363LF0000X	Family Nurse Practitioner	5005793	NC

General Provider Information

NPI Number	:	1871841312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER LOVE LATHAM FNP-BC

Provider Business Mailing Address
First Line	:	110 AUSTIN DR
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28152-9670
Country	:	US
Telephone Number	:	704-472-8025
Fax Number	:

Provider Business Practice Location Address
First Line	:	3315 SPRINGBANK LN STE 100
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-3198
Country	:	US
Telephone Number	:	704-378-8626
Fax Number	:

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

Provider Enumeration Date	:	08/15/2012
Last Update Date	:	09/25/2025

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Directions to “ AMBER LOVE LATHAM FNP-BC” Practice Location

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