Provider Demographics
NPI:1528497500
Name:FLYNN, KATHLEEN ALICE (NP)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ALICE
Last Name:FLYNN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:KATHLEEN
Other - Middle Name:ALICE
Other - Last Name:FLYNN HUTTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:836 E. 65TH STREET
Mailing Address - Street 2:SUITE 22
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405
Mailing Address - Country:US
Mailing Address - Phone:912-819-7878
Mailing Address - Fax:912-819-3555
Practice Address - Street 1:11133 ABERCORN ST.
Practice Address - Street 2:SUITE 10
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419
Practice Address - Country:US
Practice Address - Phone:912-925-3382
Practice Address - Fax:912-920-9048
Is Sole Proprietor?:No
Enumeration Date:2013-11-11
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN093508363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily