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General NPI Number Information
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NPI Number | 1538550827
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Entity Type | Individual
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Provider Name | KRISTINE LIAZ OGLESBY CNM
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Gender | Female
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Dates
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Enumeration Date | 02/09/2015
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 102 MEDICAL PARK CT
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City | CLINTON
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State | SC
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Zip | 29325-7537
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Country | US
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Telephone | 864-358-7387
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Fax | 864-938-0229
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Provider Business Mailing Address
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Address Line | 300 E MCBEE AVE STE 400
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City | GREENVILLE
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State | SC
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Zip | 29601-2899
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Country | US
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Telephone | 864-695-6697
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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 | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 19201
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | 19201
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 19201
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License Number State | SC
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