Provider Demographics
NPI:1215984299
Name:FLYNN, ADRESSA H (APRN)
Entity type:Individual
Prefix:MS
First Name:ADRESSA
Middle Name:H
Last Name:FLYNN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5130 CHARLESTOWN RD STE 2
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-9483
Mailing Address - Country:US
Mailing Address - Phone:812-949-1577
Mailing Address - Fax:
Practice Address - Street 1:5130 CHARLESTOWN RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-9483
Practice Address - Country:US
Practice Address - Phone:812-949-1577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001799A363LF0000X, 363L00000X
KY3004528363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78017787Medicaid
KY50042935OtherPASSPORT
IN200495990Medicaid
KY000000786889OtherANTHEM BC/BS
KY3004528OtherLICENSE
INM100054226Medicare PIN
KY50042935OtherPASSPORT
IN200495990Medicaid