MEDICARE: ANGELA AMICK THOMAS FNP-C, AGACNP-BC

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	363LA2100X	Acute Care Nurse Practitioner	21171	SC
2	363LF0000X	Family Nurse Practitioner	21171	SC

General Provider Information

NPI Number	:	1053834705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA AMICK THOMAS FNP-C, AGACNP-BC

Provider Business Mailing Address
First Line	:	21614 SC HIGHWAY 121
Second Line	:
City	:	WHITMIRE
State	:	SC
Zip	:	29178-9410
Country	:	US
Telephone Number	:	803-917-2496
Fax Number	:

Provider Business Practice Location Address
First Line	:	171 MONROE LN
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29072-3904
Country	:	US
Telephone Number	:	803-358-8496
Fax Number	:	866-614-3887

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

Provider Enumeration Date	:	07/24/2017
Last Update Date	:	10/24/2024

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