Provider Demographics
NPI:1740467281
Name:BOONE, AMY CLANTON (FNP)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:CLANTON
Last Name:BOONE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:AMY
Other - Middle Name:E
Other - Last Name:CLANTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-2286
Mailing Address - Fax:
Practice Address - Street 1:3308 BRUSHY CREEK RD
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650
Practice Address - Country:US
Practice Address - Phone:864-752-2000
Practice Address - Fax:864-752-2003
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3468363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP2283Medicaid