=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568859288
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELLE SMITH FLINCHUM AGNP-C FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2015
-----------------------------------------------------
Last Update Date | 05/11/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 O' KELLY AVENUE
-----------------------------------------------------
City | ELON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27244
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-278-5569
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2929 WAY RD
-----------------------------------------------------
City | LIBERTY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27298-9545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-706-1193
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 5007493
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 5007493
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------