Healthcare Provider Details

I. General information

NPI: 1255093068
Provider Name (Legal Business Name): AMANDA LEIGH EXUM APRN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2021
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

853 N CHURCH ST STE 401
SPARTANBURG SC
29303-3064
US

IV. Provider business mailing address

PO BOX 2168
SPARTANBURG SC
29304-2168
US

V. Phone/Fax

Practice location:
  • Phone: 864-560-6287
  • Fax:
Mailing address:
  • Phone: 864-560-4304
  • Fax: 864-560-4413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number22833
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: