Provider Demographics
NPI:1619926094
Name:LELAND, AMY BETH (CNM/WHNP APRN)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:BETH
Last Name:LELAND
Suffix:
Gender:F
Credentials:CNM/WHNP APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4015
Mailing Address - Country:US
Mailing Address - Phone:864-905-0255
Mailing Address - Fax:864-751-5307
Practice Address - Street 1:23 MILLS AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4015
Practice Address - Country:US
Practice Address - Phone:864-233-5513
Practice Address - Fax:864-233-5531
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
176B00000X
SC22388363LW0102X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCLM0007Medicaid