Provider Demographics
NPI:1235143793
Name:GLYNN, KATHRYN MARIE (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MARIE
Last Name:GLYNN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9990 DOUBLE R BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-4833
Mailing Address - Country:US
Mailing Address - Phone:775-348-8800
Mailing Address - Fax:775-348-8818
Practice Address - Street 1:4029 NORTHWEST AVE STE 301
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-9077
Practice Address - Country:US
Practice Address - Phone:360-752-0518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37389207L00000X
FLME92338207L00000X
WA60823734208VP0014X
NV18509208VP0014X
IL036119191207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology