Healthcare Provider Details

I. General information

NPI: 1245827369
Provider Name (Legal Business Name): AMBER TIMMONS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2020
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 W MAIN ST
LEXINGTON SC
29072-2507
US

IV. Provider business mailing address

236 LONGSPUR LN
LEXINGTON SC
29073-7503
US

V. Phone/Fax

Practice location:
  • Phone: 803-358-3100
  • Fax:
Mailing address:
  • Phone: 843-319-3006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number24488
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number24488
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: