MEDICARE: AMBER BAGWELL FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	23019	SC

General Provider Information

NPI Number	:	1043822216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER BAGWELL FNP

Provider Business Mailing Address
First Line	:	442 KING ST FL 2
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29403-6230
Country	:	US
Telephone Number	:	843-800-8110
Fax Number	:

Provider Business Practice Location Address
First Line	:	442 KING ST FL 2
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29403-6230
Country	:	US
Telephone Number	:	843-800-8110
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2020
Last Update Date	:	08/19/2020

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Directions to “ AMBER BAGWELL FNP” Practice Location

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