Nathaniel Alexander was born on March 5, 1756, in what was then Anson County, North Carolina, near the area that later developed around Concord. He grew up in the Carolina backcountry rather than in one of the colony’s older coastal towns. His father served as a local sheriff, placing the family within the small circle of officials responsible for courts, taxes, and public order in a rapidly expanding settlement region. Although surviving short biographies provide few details about his mother or siblings, the family evidently possessed enough standing and resources to secure an unusually advanced education for a backcountry son. Alexander’s childhood unfolded as settlers moved into the Piedmont and as disputes over representation, taxation, and local government sharpened in North Carolina. The work of a sheriff would have brought public controversies and the practical operation of colonial law close to the household. Such an upbringing offered an early view of civic authority, even though no surviving evidence allows particular political opinions to be assigned to the young Alexander. He was sent north to the College of New Jersey, now Princeton University, one of the most important institutions educating Presbyterian and Patriot-minded leaders in British North America. He completed a bachelor’s degree in 1776, reaching adulthood just as the colonies declared independence. A Princeton education required intensive study of classical languages, moral philosophy, rhetoric, mathematics, and natural philosophy. It also placed Alexander among students and teachers debating resistance, government, and war. After college he trained in medicine, though the precise location and supervision of that training are not well documented in standard biographies. Eighteenth-century medical preparation usually combined reading, apprenticeship, and practical observation rather than a modern professional curriculum. By 1779 Alexander was sufficiently qualified to receive a commission as a surgeon in the North Carolina Continental Line. Thus, before his later prominence as a physician and politician, he had moved from a public official’s household in the Piedmont through an elite collegiate education and into the demanding practical study of medicine during wartime.