Provider Demographics
NPI:1558764654
Name:FLORES, CHRISTY L I (NP)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:L
Last Name:FLORES
Suffix:I
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:BURNSIDE
Other - Last Name:FLORES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:225 E WOOD ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3050
Practice Address - Country:US
Practice Address - Phone:864-560-4420
Practice Address - Fax:864-560-5296
Is Sole Proprietor?:No
Enumeration Date:2014-10-02
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19082363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC52335019OtherMEDICARE PIN
SCNP3076Medicaid