Healthcare Provider Details

I. General information

NPI: 1841101136
Provider Name (Legal Business Name): BRYNN ALEXA LAFFERTY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ROUTE 73
VOORHEES NJ
08043-9575
US

IV. Provider business mailing address

102 WESSEX PL
MARLTON NJ
08053-3804
US

V. Phone/Fax

Practice location:
  • Phone: 856-282-1338
  • Fax:
Mailing address:
  • Phone: 609-410-1923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP01056200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: