Provider Demographics
NPI:1902511108
Name:BEVERLY, AMANDA GRACE (AGACNP)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:GRACE
Last Name:BEVERLY
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1601 GREENE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29208-4001
Mailing Address - Country:US
Mailing Address - Phone:803-777-7412
Mailing Address - Fax:
Practice Address - Street 1:105 VINECREST CT # 1000
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-8031
Practice Address - Country:US
Practice Address - Phone:864-725-3350
Practice Address - Fax:864-725-3351
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC28004363LA2100X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care