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General NPI Number Information
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NPI Number | 1821637992
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Entity Type | Individual
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Provider Name | KHADINE E FLYNCH NNP
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Gender | Female
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Dates
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Enumeration Date | 01/06/2020
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 1215 LEE ST
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22908-1838
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Country | US
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Telephone | 434-924-5428
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 749112
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City | ATLANTA
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State | GA
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Zip | 30374-9112
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Country | US
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Telephone | 434-295-1000
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Fax |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 0001274525
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363LN0000X
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Taxonomy Name | Neonatal Nurse Practitioner
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License Number | 0024178720
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License Number State | VA
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