Healthcare Provider Details

I. General information

NPI: 1093537896
Provider Name (Legal Business Name): KATHRYN FLYNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2024
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 THORNTON AVE STE 101
DES MOINES IA
50321-2422
US

IV. Provider business mailing address

1316 S MAIN ST
CLARION IA
50525-2019
US

V. Phone/Fax

Practice location:
  • Phone: 515-327-2000
  • Fax:
Mailing address:
  • Phone: 844-474-4321
  • Fax: 319-343-1161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number01164
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: