Provider Demographics
NPI:1003275132
Name:FLYNN, MICHAEL PATRICK (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PATRICK
Last Name:FLYNN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 20TH ST STE 503
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1832
Mailing Address - Country:US
Mailing Address - Phone:865-331-4321
Mailing Address - Fax:865-374-2078
Practice Address - Street 1:501 20TH ST STE 503
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1832
Practice Address - Country:US
Practice Address - Phone:865-331-4321
Practice Address - Fax:865-331-4320
Is Sole Proprietor?:No
Enumeration Date:2016-02-17
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2978363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ020113Medicaid