Healthcare Provider Details

I. General information

NPI: 1538550827
Provider Name (Legal Business Name): KRISTINE LIAZ OGLESBY CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2015
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 MEDICAL PARK CT
CLINTON SC
29325-7537
US

IV. Provider business mailing address

300 E MCBEE AVE STE 400
GREENVILLE SC
29601-2899
US

V. Phone/Fax

Practice location:
  • Phone: 864-358-7387
  • Fax: 864-938-0229
Mailing address:
  • Phone: 864-695-6697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number19201
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number19201
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number19201
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: