Healthcare Provider Details

I. General information

NPI: 1982508339
Provider Name (Legal Business Name): GAVIN ALAN FLYNN PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8660 W EMERALD ST STE 112
BOISE ID
83704-4829
US

IV. Provider business mailing address

8660 W EMERALD ST STE 112
BOISE ID
83704-4829
US

V. Phone/Fax

Practice location:
  • Phone: 208-314-1770
  • Fax:
Mailing address:
  • Phone: 208-314-1770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1481434
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: