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General NPI Number Information
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NPI Number | 1083712327
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Entity Type | Individual
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Provider Name | JODI FLYNN PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 589 S STATE ST
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City | PROVO
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State | UT
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Zip | 84606-5056
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Country | US
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Telephone | 801-602-4795
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Fax |
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Provider Business Mailing Address
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Address Line | 582 PARK PLACE DR
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City | BRIGHTON
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State | CO
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Zip | 80601-2689
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Country | US
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Telephone | 417-299-2905
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Fax | 970-230-6438
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 2003002309
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 13724198-1206
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License Number State | UT
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