Providence Medical LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

PROVIDENCE MEDICAL LLC

Practice address

424 Lewis Hargett Cir Ste 250
Lexington, KY 40503-3687

Phone

(803) 240-2847

NPI assigned

Oct 7, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Amy McKissick, NPNPI 1861469488

Title

Nurse Practitioner

Phone

(803) 240-2847

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Amy McKissick, N.P.

  • Family Nurse Practitioner
  • Columbia, SC
  • NPI 1861469488
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1728259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728259200000",
    "number": "1871312918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 SUMMERVILLE AVE",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292011927",
            "telephone_number": "803-240-2847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "424 LEWIS HARGETT CIR STE 250",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405033687",
            "telephone_number": "803-240-2847"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1501 Main St Ste 501",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "SC",
            "postal_code": "292015801",
            "country_code": "US",
            "telephone_number": "803-240-2847",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROVIDENCE MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-07",
        "last_updated": "2024-10-07",
        "certification_date": "2024-10-07",
        "status": "A",
        "authorized_official_last_name": "MCKISSICK",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "803-240-2847",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joann M Prosser, LMT
• Prosthetic and Orthotic Associates,LLC
• Prosthetic and Orthotic Limited
• Glenn R Proudfoot, MD
• Ian Lee Provancha, MD
• Janalyn Prows, M.D.
• Jinger Renee Pruden, M.A., CCC-A
• Robert James Pruden, PT
• Samuel J Pruden II, MD
• Brandon Pruitt, MD

• Family Medicine Physician in Lexington, KY
• Providers in Lexington, KY by specialty
• Family Medicine Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.