Provider Demographics
NPI:1063039311
Name:FLENTGE, GAVIN LEE (AGACNP-BC)
Entity Type:Individual
Prefix:MR
First Name:GAVIN
Middle Name:LEE
Last Name:FLENTGE
Suffix:
Gender:M
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8 N FRENCH LN
Mailing Address - Street 2:
Mailing Address - City:PERRYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63775-1577
Mailing Address - Country:US
Mailing Address - Phone:573-768-6986
Mailing Address - Fax:949-655-8621
Practice Address - Street 1:8 N FRENCH LN
Practice Address - Street 2:
Practice Address - City:PERRYVILLE
Practice Address - State:MO
Practice Address - Zip Code:63775-1577
Practice Address - Country:US
Practice Address - Phone:573-768-6986
Practice Address - Fax:949-655-8621
Is Sole Proprietor?:No
Enumeration Date:2020-07-02
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020019956363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care