Healthcare Provider Details

I. General information

NPI: 1962960625
Provider Name (Legal Business Name): AMELIA J TAYLOR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2019
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 PALMETTO POINTE RD
MARION SC
29571-6721
US

IV. Provider business mailing address

145 PALMETTO POINTE RD
MARION SC
29571-6721
US

V. Phone/Fax

Practice location:
  • Phone: 843-248-4700
  • Fax:
Mailing address:
  • Phone: 843-423-2400
  • Fax: 843-423-3432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22658
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: