Healthcare Provider Details

I. General information

NPI: 1174574446
Provider Name (Legal Business Name): MELISSA BLAND FLYNN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 HELMWOOD PLAZA DR
ELIZABETHTOWN KY
42701
US

IV. Provider business mailing address

111 HELMWOOD PLAZA DR
ELIZABETHTOWN KY
42701
US

V. Phone/Fax

Practice location:
  • Phone: 270-737-4808
  • Fax: 270-737-4939
Mailing address:
  • Phone: 270-737-4808
  • Fax: 270-737-4939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberKY33919
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: