=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366326795
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ENGLISH KINKEAD FLAHERTY MMS, PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2025
-----------------------------------------------------
Last Update Date | 09/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 935 STATE FARM RD
-----------------------------------------------------
City | BOONE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28607-4948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-262-3886
-----------------------------------------------------
Fax | 828-265-4816
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1490
-----------------------------------------------------
City | BOONE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28607-0682
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-262-3886
-----------------------------------------------------
Fax | 828-265-4816
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 0010-15590
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------