Healthcare Provider Details

I. General information

NPI: 1083422596
Provider Name (Legal Business Name): AMANDA LEE BAXTER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2024
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

542 NEW CUT MEADOWS RD
INMAN SC
29349-5200
US

IV. Provider business mailing address

542 NEW CUT MEADOWS RD
INMAN SC
29349-5200
US

V. Phone/Fax

Practice location:
  • Phone: 864-982-4302
  • Fax:
Mailing address:
  • Phone: 864-982-4302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number29737
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5023623
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: