Healthcare Provider Details

I. General information

NPI: 1013610864
Provider Name (Legal Business Name): AMANDA PAIGE WOOTEN AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA PAIGE STUEMKE RN

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 PLANTATION PARK DR STE 203
BLUFFTON SC
29910-9008
US

IV. Provider business mailing address

4 FEREBEE CT
BLUFFTON SC
29910-6569
US

V. Phone/Fax

Practice location:
  • Phone: 854-235-2830
  • Fax:
Mailing address:
  • Phone: 336-608-7522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number27192
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number27192
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: