Healthcare Provider Details

I. General information

NPI: 1518833516
Provider Name (Legal Business Name): AMY REBECCA FLYNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2025
Last Update Date: 10/19/2025
Certification Date: 10/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 19TH STREET SOUTH
BIRMINGHAM AL
35294-1801
US

IV. Provider business mailing address

619 19TH ST S
BIRMINGHAM AL
35233-1900
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-3411
  • Fax:
Mailing address:
  • Phone: 205-934-3411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-094345
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: