Provider Demographics
NPI:1598088460
Name:FLYNN, KIMBERLY LOCKWOOD (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:LOCKWOOD
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 1:5809 SUNSHINE PARK DR
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-5540
Mailing Address - Country:US
Mailing Address - Phone:727-842-3770
Mailing Address - Fax:727-842-3770
Practice Address - Street 1:5809 SUNSHINE PARK DR
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-5540
Practice Address - Country:US
Practice Address - Phone:727-842-3770
Practice Address - Fax:727-842-3770
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105328363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant