AMANDA MAYS LACK APRN NPI 1124532528

NPI Information

NPI: 1124532528
Provider Name: AMANDA MAYS LACK, APRN
Classification: Nurse Practitioner - 363LG0600X
Entity Type: Individual

Specialization: Gerontology

PECOS Registration: Yes

Address:
108 HIGHWAY 28 BYP
ANDERSON, SC
ZIP 29624
Phone: (864) 772-8173
Get Directions

Amanda Mays Lack, APRN is a gerontology nurse practitioner in Anderson, SC with 7 years of experience. Amanda Mays Lack, APRN NPI is 1124532528. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

108 HIGHWAY 28 BYP
ANDERSON, SC
ZIP 29624-742
Phone: (864) 772-8173
Fax: (833) 996-1161

The NPI 1124532528 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 11/21/2017 and was last updated on 12/14/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LA2200X	Nurse Practitioner	Adult Health	RN162689	GEORGIA	No
2	363LG0600X	Nurse Practitioner	Gerontology	23238	SOUTH CAROLINA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	NP6410	MEDICAID	SOUTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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