Healthcare Provider Details

I. General information

NPI: 1891392783
Provider Name (Legal Business Name): BETHANY FLYNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 10/05/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 HEALY SPUR RD
HEALY AK
99743
US

IV. Provider business mailing address

137 HEALY SPUR RD
HEALY AK
99743
US

V. Phone/Fax

Practice location:
  • Phone: 907-683-2223
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number110716
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: