Provider Demographics
NPI:1013610864
Name:WOOTEN, AMANDA PAIGE (AGPCNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:PAIGE
Last Name:WOOTEN
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:PAIGE
Other - Last Name:STUEMKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4 FEREBEE CT
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-6569
Mailing Address - Country:US
Mailing Address - Phone:336-608-7522
Mailing Address - Fax:
Practice Address - Street 1:93 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926-6613
Practice Address - Country:US
Practice Address - Phone:843-681-3777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27192363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology