Healthcare Provider Details

I. General information

NPI: 1578284188
Provider Name (Legal Business Name): JOHN KEVIN FLYNN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 5071 BOX MEDICAL
APO AP
96328-5071
US

IV. Provider business mailing address

UNIT 5071 BOX MEDICAL
APO AP
96328-5071
US

V. Phone/Fax

Practice location:
  • Phone: 315-225-3566
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number13378156-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: