Healthcare Provider Details

I. General information

NPI: 1275583262
Provider Name (Legal Business Name): KATHLEEN P. FLYNN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 10/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 KNOX ST KNOX FAMILY MEDICINE
BARBOURVILLE KY
40906-1304
US

IV. Provider business mailing address

602 KNOX ST KNOX FAMILY MEDICINE
BARBOURVILLE KY
40906-1304
US

V. Phone/Fax

Practice location:
  • Phone: 606-546-6027
  • Fax: 606-546-2084
Mailing address:
  • Phone: 606-546-6027
  • Fax: 606-546-2084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA011
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: