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General NPI Number Information
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NPI Number | 1194565515
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Entity Type | Individual
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Provider Name | AMANDA LYNN WHITEHEAD NP
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Gender | Female
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Dates
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Enumeration Date | 05/31/2024
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | 115 BLARNEY DR
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City | COLUMBIA
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State | SC
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Zip | 29223-6291
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Country | US
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Telephone | 803-254-5171
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Fax |
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Provider Business Mailing Address
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Address Line | 125 LIVING WATERS BLVD
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City | LEXINGTON
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State | SC
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Zip | 29073-8422
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Country | US
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Telephone | 484-714-7007
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0000X
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Taxonomy Name | Adolescent Medicine (Family Medicine) Physician
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License Number | APN.29187
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | APN.29187
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN.29187
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License Number State | SC
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