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General NPI Number Information
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NPI Number | 1831900430
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Entity Type | Individual
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Provider Name | AMELIA JESSIE BREAZEALE SEYBOLD PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/14/2025
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 501 W BUTLER RD STE CANDE
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City | GREENVILLE
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State | SC
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Zip | 29607-4879
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Country | US
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Telephone | 864-214-1188
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Fax | 864-214-1188
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Provider Business Mailing Address
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Address Line | 501 W BUTLER RD STE C&E
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City | GREENVILLE
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State | SC
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Zip | 29607-4879
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Country | US
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Telephone | 864-214-1188
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 30584
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License Number State | SC
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