Provider Demographics
NPI:1275583262
Name:FLYNN, KATHLEEN P (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:P
Last Name:FLYNN
Suffix:
Gender:F
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 1:602 KNOX ST
Mailing Address - Street 2:KNOX FAMILY MEDICINE
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-1304
Mailing Address - Country:US
Mailing Address - Phone:606-546-6027
Mailing Address - Fax:606-546-2084
Practice Address - Street 1:602 KNOX ST
Practice Address - Street 2:KNOX FAMILY MEDICINE
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-1304
Practice Address - Country:US
Practice Address - Phone:606-546-6027
Practice Address - Fax:606-546-2084
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA011363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95002648Medicaid
KY0658611Medicare ID - Type Unspecified
KY95002648Medicaid