Healthcare Provider Details

I. General information

NPI: 1801895149
Provider Name (Legal Business Name): KATHLEEN FLYNN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN FLYNN M.D.

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 07/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4551 NEW BERN AVE STE 160
RALEIGH NC
27610-1552
US

IV. Provider business mailing address

260 HORIZON DR
RALEIGH NC
27615-4922
US

V. Phone/Fax

Practice location:
  • Phone: 919-861-7793
  • Fax:
Mailing address:
  • Phone: 919-488-0015
  • Fax: 919-277-0066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number034168
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2009-02005
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: