Healthcare Provider Details

I. General information

NPI: 1649494451
Provider Name (Legal Business Name): KERRIE E FLYNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 01/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 HARRISON AVE 1 BOSTON MEDICAL CENTER ACC5
BOSTON MA
02118-4001
US

IV. Provider business mailing address

31 WOODBINE ST
AUBURNDALE MA
02466-1808
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-5170
  • Fax:
Mailing address:
  • Phone: 617-965-2547
  • Fax: 617-965-2780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number#F0606131
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: