MEDICARE: ELEVATED WELLNESS

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1063361947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEVATED WELLNESS

Provider Business Mailing Address
First Line	:	2100 N BELTLINE BLVD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-3905
Country	:	US
Telephone Number	:	803-667-5644
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 N BELTLINE BLVD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-3905
Country	:	US
Telephone Number	:	803-667-5644
Fax Number	:

Authorized Official
Title or Position	:	OWNER, NURSE PRACTITIONER
Name	:	AMANDA S CLARK
Credential	:	DNP, MSN, FNP-BC
Telephone Number	:	803-667-5644

Provider Enumeration Date	:	01/24/2026
Last Update Date	:	01/24/2026

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Directions to “ELEVATED WELLNESS ” Practice Location

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