Provider Demographics
NPI:1346887189
Name:FLYNN, ANDREA C (NP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:C
Last Name:FLYNN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W CENTRAL TEXAS EXPY STE 290
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-1991
Mailing Address - Country:US
Mailing Address - Phone:254-618-1151
Mailing Address - Fax:254-618-1158
Practice Address - Street 1:800 W CENTRAL TEXAS EXPY STE 290
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-1991
Practice Address - Country:US
Practice Address - Phone:254-618-1151
Practice Address - Fax:254-618-1158
Is Sole Proprietor?:No
Enumeration Date:2019-11-27
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP144104363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX748632OtherTEXAS RN LICENSE
TXAP144104OtherTEXAS NP LICENSE