Healthcare Provider Details

I. General information

NPI: 1053834705
Provider Name (Legal Business Name): ANGELA AMICK THOMAS FNP-C, AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA RENEE AMICK FNP-C, AGACNP-BC

II. Dates (important events)

Enumeration Date: 07/24/2017
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 MONROE LN
LEXINGTON SC
29072-3904
US

IV. Provider business mailing address

21614 SC HIGHWAY 121
WHITMIRE SC
29178-9410
US

V. Phone/Fax

Practice location:
  • Phone: 803-358-8496
  • Fax: 866-614-3887
Mailing address:
  • Phone: 803-917-2496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number21171
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21171
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: