Healthcare Provider Details

I. General information

NPI: 1295126795
Provider Name (Legal Business Name): ASHLEY BROOKE FLYNN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY BROOKE WINSTEAD

II. Dates (important events)

Enumeration Date: 02/05/2015
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12450 LA GRANGE RD
LOUISVILLE KY
40245
US

IV. Provider business mailing address

2620 ELM HILL PIKE
NASHVILLE TN
37214-3108
US

V. Phone/Fax

Practice location:
  • Phone: 502-638-4783
  • Fax:
Mailing address:
  • Phone: 615-425-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3009355
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1128790
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: