Provider Demographics
NPI:1629317045
Name:CALHOUN, AMANDA LEWIS (NP-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEWIS
Last Name:CALHOUN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:BROOKE
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-390-0100
Mailing Address - Fax:843-390-0038
Practice Address - Street 1:3980 HIGHWAY 9 E STE 200
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-8164
Practice Address - Country:US
Practice Address - Phone:843-903-4111
Practice Address - Fax:843-903-4242
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006071363LF0000X
SC18141363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP2410Medicaid