Individual
AMY SOUTHERN CLINTON
Active
Individual
AMY SOUTHERN CLINTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
3559
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3559
SC LISCENSE
SC
05
—
7004446
—
NC
01
—
AA27553365
MEDICARE PIN
SC
01
—
AA27554746
MEDICARE PIN
SC
01
—
AA27555019
MEDICARE PIN
SC
05
—
NP1262
—
SC
01
—
P00692350
RR MEDICARE
SC
Enumeration date
05/21/2008
Last updated
03/03/2023
Update your record
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