Healthcare Provider Details

I. General information

NPI: 1457467060
Provider Name (Legal Business Name): TIMOTHY J FLYNN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 03/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20375 W 151ST ST SUITE 306
OLATHE KS
66061-5306
US

IV. Provider business mailing address

20375 W 151ST ST SUITE 306
OLATHE KS
66061-5306
US

V. Phone/Fax

Practice location:
  • Phone: 913-782-2292
  • Fax: 913-782-2381
Mailing address:
  • Phone: 913-782-2292
  • Fax: 913-782-2381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number54412
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number069074
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number45701
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: