Healthcare Provider Details

I. General information

NPI: 1811394885
Provider Name (Legal Business Name): AMANDA REYNOLDS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2014
Last Update Date: 02/07/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4575 8TH DIVISION ROAD
COLUMBIA SC
29207
US

IV. Provider business mailing address

64 BELLSIDE LN
ELGIN SC
29045-5501
US

V. Phone/Fax

Practice location:
  • Phone: 803-751-7826
  • Fax: 803-751-4438
Mailing address:
  • Phone: 828-446-0106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001238577
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number244621
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: