Healthcare Provider Details

I. General information

NPI: 1205512951
Provider Name (Legal Business Name): ALLISSA TAYLOR FLYNN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5055 A ST STE 300
LINCOLN NE
68510-4970
US

IV. Provider business mailing address

5055 A ST STE 300
LINCOLN NE
68510-4970
US

V. Phone/Fax

Practice location:
  • Phone: 402-488-5600
  • Fax:
Mailing address:
  • Phone: 402-488-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3218
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: