Provider Demographics
NPI:1083924948
Name:FLYNN, JUDY ELLEN (PA)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:ELLEN
Last Name:FLYNN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 NORTH 12TH STREET
Mailing Address - Street 2:PO BOX 568
Mailing Address - City:CORNELIUS
Mailing Address - State:OR
Mailing Address - Zip Code:97113
Mailing Address - Country:US
Mailing Address - Phone:503-352-8562
Mailing Address - Fax:503-352-7089
Practice Address - Street 1:2935 SW CEDAR HILLS BLVD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005
Practice Address - Country:US
Practice Address - Phone:503-352-8562
Practice Address - Fax:503-352-7089
Is Sole Proprietor?:No
Enumeration Date:2010-10-13
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00428363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical