Provider Demographics
NPI:1013357284
Name:ROGERS, AMANDA BONIFACE (DNP, ANP-C)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:BONIFACE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:DNP, ANP-C
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:QUINN
Other - Last Name:BONIFACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, ANP-C
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:2995 REIDVILLE RD STE 210
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-5631
Practice Address - Country:US
Practice Address - Phone:864-253-8140
Practice Address - Fax:864-587-0051
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18343363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP2544Medicaid
SCSCP0295019OtherMEDICARE PIN