MEDICARE: AMANDA NELSON FNP-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	363LF0000X	Family Nurse Practitioner	5022054	NC

General Provider Information

NPI Number	:	1467281196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA NELSON FNP-BC

Provider Business Mailing Address
First Line	:	125 W CATAWBA AVE
Second Line	:
City	:	MOUNT HOLLY
State	:	NC
Zip	:	28120-1601
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 W CATAWBA AVE
Second Line	:
City	:	MOUNT HOLLY
State	:	NC
Zip	:	28120-1601
Country	:	US
Telephone Number	:	704-827-3014
Fax Number	:

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

Provider Enumeration Date	:	07/31/2024
Last Update Date	:	01/22/2026

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