Provider Demographics
NPI:1104622190
Name:FLYNN, NICOLE (NTP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:FLYNN
Suffix:
Gender:
Credentials:NTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NICHOLS HILLS
Mailing Address - State:OK
Mailing Address - Zip Code:73116-6207
Mailing Address - Country:US
Mailing Address - Phone:419-508-7753
Mailing Address - Fax:
Practice Address - Street 1:1118 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:NICHOLS HILLS
Practice Address - State:OK
Practice Address - Zip Code:73116-6207
Practice Address - Country:US
Practice Address - Phone:419-508-7753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach