Healthcare Provider Details

I. General information

NPI: 1053132571
Provider Name (Legal Business Name): KAITLYN ELIZABETH FLYNN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

863 N MAIN STREET EXT STE 101
WALLINGFORD CT
06492-2434
US

IV. Provider business mailing address

85 STAFFORDSHIRE COMMONS DR
WALLINGFORD CT
06492-1757
US

V. Phone/Fax

Practice location:
  • Phone: 203-269-3791
  • Fax:
Mailing address:
  • Phone: 203-980-1269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12.014027
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: