Provider Demographics
NPI:1962462234
Name:FLINN, WESLEY L (PA-C)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:L
Last Name:FLINN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1393 CELANESE RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1722
Mailing Address - Country:US
Mailing Address - Phone:803-329-3103
Mailing Address - Fax:803-325-2232
Practice Address - Street 1:1393 CELANESE RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1722
Practice Address - Country:US
Practice Address - Phone:803-329-3103
Practice Address - Fax:803-325-2232
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC267363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
E1568OtherMEDCOST
SC0425PAMedicaid
SC0425PAMedicaid
E1568OtherMEDCOST