Healthcare Provider Details

I. General information

NPI: 1104705540
Provider Name (Legal Business Name): AMANDA LEIGH DAWKINS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2025
Last Update Date: 08/29/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 KINGS MOUNTAIN ST
YORK SC
29745-1168
US

IV. Provider business mailing address

224 KINGS MOUNTAIN ST
YORK SC
29745-1168
US

V. Phone/Fax

Practice location:
  • Phone: 704-507-5849
  • Fax:
Mailing address:
  • Phone: 704-507-5849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number28316
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: