Provider Demographics
NPI:1972547362
Name:SMITH, AMY C (APRN)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:C
Last Name:SMITH
Suffix:
Gender:
Credentials:APRN
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:N
Other - Last Name:CRIBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 421718
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29442-4203
Mailing Address - Country:US
Mailing Address - Phone:843-527-7000
Mailing Address - Fax:
Practice Address - Street 1:1011 N FRASER ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-2848
Practice Address - Country:US
Practice Address - Phone:843-527-3428
Practice Address - Fax:843-546-8216
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2767363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1009Medicaid
SCNP1009Medicaid