Healthcare Provider Details

I. General information

NPI: 1548326176
Provider Name (Legal Business Name): BERNADINE KAY FLYNN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14415 192ND AVENUE CT E
BONNEY LAKE WA
98391-9638
US

IV. Provider business mailing address

14415 192ND AVENUE CT E
BONNEY LAKE WA
98391-9638
US

V. Phone/Fax

Practice location:
  • Phone: 253-948-6194
  • Fax:
Mailing address:
  • Phone: 253-948-6194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP30004450
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: