Healthcare Provider Details

I. General information

NPI: 1649608373
Provider Name (Legal Business Name): KELLY FLYNT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2013
Last Update Date: 10/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N ELM ST
HIGH POINT NC
27262-4331
US

IV. Provider business mailing address

601 N ELM ST
HIGH POINT NC
27262-4331
US

V. Phone/Fax

Practice location:
  • Phone: 336-878-6000
  • Fax: 336-878-6156
Mailing address:
  • Phone: 336-878-6000
  • Fax: 336-878-6156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number176735
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: