Healthcare Provider Details

I. General information

NPI: 1972010866
Provider Name (Legal Business Name): KATHRYN MARY FLYNN DNP, PHNA-BC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2018
Last Update Date: 01/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 CYPRESS POINT DR
EGG HARBOR CITY NJ
08215-5124
US

IV. Provider business mailing address

671 CYPRESS POINT DR
EGG HARBOR CITY NJ
08215-5124
US

V. Phone/Fax

Practice location:
  • Phone: 609-457-5365
  • Fax:
Mailing address:
  • Phone: 609-457-5365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number26NR06238700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License Number26NR06238700
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number29NR06238700
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number26NR06238700
License Number StateNJ
# 5
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number26NR06238700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: