Provider Demographics
NPI:1104436799
Name:RODGERS, AMY MARIE (FNP-BC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:RODGERS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:MARIE
Other - Last Name:MORRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 887
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29620-0887
Mailing Address - Country:US
Mailing Address - Phone:864-366-1649
Mailing Address - Fax:864-366-3317
Practice Address - Street 1:6 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:DUE WEST
Practice Address - State:SC
Practice Address - Zip Code:29639-9554
Practice Address - Country:US
Practice Address - Phone:864-379-2345
Practice Address - Fax:864-379-3228
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24049363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily