Provider Demographics
NPI:1457467060
Name:FLYNN, TIMOTHY J (CRNA)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:FLYNN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20375 W 151ST ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-5306
Mailing Address - Country:US
Mailing Address - Phone:913-782-2292
Mailing Address - Fax:913-782-2381
Practice Address - Street 1:20375 W 151ST ST
Practice Address - Street 2:SUITE 306
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-5306
Practice Address - Country:US
Practice Address - Phone:913-782-2292
Practice Address - Fax:913-782-2381
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS54412367500000X
MO069074367500000X
KS45701163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200540360AMedicaid
MO912861903Medicaid
KSP00606532OtherRR MEDICARE
MO18441011OtherBCBS OF KANSAS CITY
MO18441011OtherBCBS OF KANSAS CITY
KS200540360AMedicaid
MO430029236Medicare ID - Type UnspecifiedRAILROAD MEDICARE