Healthcare Provider Details

I. General information

NPI: 1447325360
Provider Name (Legal Business Name): JANNA KIRSTEN FLINT WILSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANNA KIRSTEN FLINT MD

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4704 AMBASSADOR CAFFERY PKWY
LAFAYETTE LA
70508-6908
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 337-470-5920
  • Fax: 337-289-9860
Mailing address:
  • Phone: 337-470-5920
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberMD.202173
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number036.118014
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: