Provider Demographics
NPI:1962236125
Name:FLYNN, RACHAEL NICOLE (FNP-BC)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:NICOLE
Last Name:FLYNN
Suffix:
Gender:
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 W HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-3734
Mailing Address - Country:US
Mailing Address - Phone:539-367-4500
Mailing Address - Fax:
Practice Address - Street 1:1251 W HOUSTON ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-3734
Practice Address - Country:US
Practice Address - Phone:539-367-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-29
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS906911363LF0000X
OK221283363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily