Provider Demographics
NPI:1437356730
Name:FLITTON, JOHNNY LYNN (PA)
Entity Type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:LYNN
Last Name:FLITTON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4214 ANDREWS HWY STE 240
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-4817
Mailing Address - Country:US
Mailing Address - Phone:432-686-6605
Mailing Address - Fax:432-682-2284
Practice Address - Street 1:3401 GREENBRIAR
Practice Address - Street 2:SUITE 200
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-4652
Practice Address - Country:US
Practice Address - Phone:432-618-5215
Practice Address - Fax:432-618-5253
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
TXPA05053363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX079837301Medicaid