Provider Demographics
NPI:1639208531
Name:FLETCHER, AMY VINES (FNP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:VINES
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:VINES
Other - Last Name:SOMAINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
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 1:475 HEYWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1762
Practice Address - Country:US
Practice Address - Phone:864-699-5020
Practice Address - Fax:864-699-5050
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCF2995363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1345Medicaid
SCNP1345Medicaid