Healthcare Provider Details

I. General information

NPI: 1003348418
Provider Name (Legal Business Name): BRIANNE FLYNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 N STEMMONS FWY
DALLAS TX
75207-2703
US

IV. Provider business mailing address

1212 SINGLETON BLVD APT 4015
DALLAS TX
75212-5387
US

V. Phone/Fax

Practice location:
  • Phone: 214-920-5900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD472926
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: