Provider Demographics
NPI:1720488851
Name:FLYNN, ALEXANDRA ESTHER (CPNP)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:ESTHER
Last Name:FLYNN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:E
Other - Last Name:MAXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 602195
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2195
Mailing Address - Country:US
Mailing Address - Phone:877-498-4490
Mailing Address - Fax:
Practice Address - Street 1:2815 KIDD RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1843
Practice Address - Country:US
Practice Address - Phone:919-231-5515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-26
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5012453363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1720488851Medicaid
SCNP2935Medicaid