Healthcare Provider Details

I. General information

NPI: 1730986662
Provider Name (Legal Business Name): KATHRYN JOY FLYNN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

454 E BROAD ST
ROCHESTER NY
14607-1724
US

IV. Provider business mailing address

6766 BEAR SWAMP RD
WILLIAMSON NY
14589-9750
US

V. Phone/Fax

Practice location:
  • Phone: 585-276-7640
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number353067
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: