Provider Demographics
NPI:1154752780
Name:EVANS, AMANDA GIBSON (FNP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:GIBSON
Last Name:EVANS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:325 MEDICAL PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-2457
Practice Address - Country:US
Practice Address - Phone:864-797-9550
Practice Address - Fax:864-797-9555
Is Sole Proprietor?:No
Enumeration Date:2013-12-08
Last Update Date:2021-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18582363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP2669Medicaid