Provider Demographics
NPI:1497455117
Name:SMALL, AMBER LEIGH (FNP-C)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LEIGH
Last Name:SMALL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 E HOSPITAL DR STE 400
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-4800
Mailing Address - Country:US
Mailing Address - Phone:803-739-3387
Mailing Address - Fax:803-936-7735
Practice Address - Street 1:146 E HOSPITAL DR STE 400
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4800
Practice Address - Country:US
Practice Address - Phone:803-936-3300
Practice Address - Fax:803-936-7735
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCRN216085163W00000X
GARN266001163W00000X
SC27172363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily