Healthcare Provider Details

I. General information

NPI: 1528497500
Provider Name (Legal Business Name): KATHLEEN ALICE FLYNN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN ALICE FLYNN HUTTON NP

II. Dates (important events)

Enumeration Date: 11/11/2013
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11133 ABERCORN ST. SUITE 10
SAVANNAH GA
31419
US

IV. Provider business mailing address

836 E. 65TH STREET SUITE 22
SAVANNAH GA
31405
US

V. Phone/Fax

Practice location:
  • Phone: 912-925-3382
  • Fax: 912-920-9048
Mailing address:
  • Phone: 912-819-7878
  • Fax: 912-819-3555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN093508
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: