Healthcare Provider Details

I. General information

NPI: 1528570579
Provider Name (Legal Business Name): KRISTIN TERESE FLYNN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2017
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 BEAUVOIR AVE
SUMMIT NJ
07901-3533
US

IV. Provider business mailing address

40 MAIN ST
CHATHAM NJ
07928-2431
US

V. Phone/Fax

Practice location:
  • Phone: 908-522-2000
  • Fax:
Mailing address:
  • Phone: 973-635-0800
  • Fax: 973-635-6254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00774500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: