Provider Demographics
NPI:1871121269
Name:FLINCHUM, BETHANY SHAFFER (PA-C)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:SHAFFER
Last Name:FLINCHUM
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:ERIN
Other - Last Name:SHAFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 603949
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3949
Mailing Address - Country:US
Mailing Address - Phone:919-350-0351
Mailing Address - Fax:919-350-7687
Practice Address - Street 1:10880 DURANT RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6629
Practice Address - Country:US
Practice Address - Phone:919-235-6509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-31
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-10527261QP2300X, 363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1871121269Medicaid