MEDICARE: ALEXANDRA ESTHER FLYNN CPNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	5012453	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720488851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA ESTHER FLYNN CPNP

Provider Business Mailing Address
First Line	:	PO BOX 602195
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-2195
Country	:	US
Telephone Number	:	877-498-4490
Fax Number	:

Provider Business Practice Location Address
First Line	:	2815 KIDD RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-1843
Country	:	US
Telephone Number	:	919-231-5515
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2014
Last Update Date	:	02/14/2023

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