Healthcare Provider Details

I. General information

NPI: 1417165630
Provider Name (Legal Business Name): JENNIFER ELIZABETH FLYTHE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2007
Last Update Date: 09/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7024 BURNETT WOMACK CB 7155
CHAPEL HILL NC
27599-7155
US

IV. Provider business mailing address

7024 BURNETT WOMACK CB 7155
CHAPEL HILL NC
27599-7155
US

V. Phone/Fax

Practice location:
  • Phone: 919-445-2656
  • Fax: 919-966-4251
Mailing address:
  • Phone: 919-445-2656
  • Fax: 919-966-4251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number2014-00187
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: