Healthcare Provider Details

I. General information

NPI: 1396389383
Provider Name (Legal Business Name): SEAN FLYNN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2019
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6225 N STATE HIGHWAY 161 STE 200
IRVING TX
75038-2241
US

IV. Provider business mailing address

1301 CHEROKEE ROSE LN
BURLESON TX
76028-0501
US

V. Phone/Fax

Practice location:
  • Phone: 214-687-0001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number871958
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP144929
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: