Provider Demographics
NPI:1720603202
Name:KINARD, AMY ELLIS (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ELLIS
Last Name:KINARD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 WREN ST
Mailing Address - Street 2:
Mailing Address - City:BARNWELL
Mailing Address - State:SC
Mailing Address - Zip Code:29812-1529
Mailing Address - Country:US
Mailing Address - Phone:803-259-5762
Mailing Address - Fax:803-592-3250
Practice Address - Street 1:130 BAKER ST N
Practice Address - Street 2:
Practice Address - City:BLACKVILLE
Practice Address - State:SC
Practice Address - Zip Code:29817-2426
Practice Address - Country:US
Practice Address - Phone:803-284-1045
Practice Address - Fax:803-284-3094
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24084363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSCI941OtherMEDICARE
SCNP7029Medicaid