| Amanda C Ivey, FNP-C | |
|
1200 Village Harbor Dr, Lake Wylie, SC 29710-9092 | |
| (803) 631-2858 | |
| (803) 631-2862 |
| Full Name | Amanda C Ivey |
|---|---|
| Gender | Female |
| Speciality | Nurse Practitioner - Family |
| Location | 1200 Village Harbor Dr, Lake Wylie, South Carolina |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770970873 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363LF0000X | Nurse Practitioner - Family | 19257 (South Carolina) | Primary |
| 363LF0000X | Nurse Practitioner - Family | 5008474 (North Carolina) | Secondary |
| Entity Name | Caromont Medical Group Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1568641165 PECOS PAC ID: 3577476258 Enrollment ID: O20041021000318 |
| Entity Name | Providence House Calls Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1689912495 PECOS PAC ID: 1759528250 Enrollment ID: O20130430000366 |
| Entity Name | Elite Patient Care Of South Carolina Pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1316477896 PECOS PAC ID: 1951672617 Enrollment ID: O20170731000866 |
| Mailing Address | Practice Location Address |
|---|---|
| Amanda C Ivey, FNP-C 1200 Village Harbor Dr, Lake Wylie, SC 29710-9092 Ph: (803) 631-2858 | Amanda C Ivey, FNP-C 1200 Village Harbor Dr, Lake Wylie, SC 29710-9092 Ph: (803) 631-2858 |
Kristen Jean Burns, FNP-C Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 1200 Village Harbor Dr, Lake Wylie, SC 29710 Phone: 803-631-2858 Fax: 803-631-2862 | |
Peter A. Bertelli, MSN, APRN, PMHNP-BC Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 244 Latitude Ln Ste 104, Lake Wylie, SC 29710 Phone: 803-809-3184 Fax: 803-615-4662 | |
Mrs. Freedom Lee Proctor, CRNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 1516 Village Harbor Dr, Lake Wylie, SC 29710 Phone: 803-752-4200 Fax: 803-752-4300 | |
Ramanjit Kaur, Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 2495 Napa Ter, Lake Wylie, SC 29710 Phone: 201-755-7369 |