Healthcare Provider Details

I. General information

NPI: 1043424930
Provider Name (Legal Business Name): ELIZABETH ANN FLYNN MS, APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 HERRING AVE SUITE 306
WACO TX
76708-3245
US

IV. Provider business mailing address

2911 HERRING AVE SUITE 306
WACO TX
76708-3245
US

V. Phone/Fax

Practice location:
  • Phone: 254-755-4559
  • Fax: 254-755-4549
Mailing address:
  • Phone: 254-755-4559
  • Fax: 254-755-4549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number431613
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: