Provider Demographics
NPI:1669864195
Name:FLYNN, CHARLES (NP-C)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:FLYNN
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 MADDOX SIMPSON PKWY
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37090-0751
Mailing Address - Country:US
Mailing Address - Phone:615-444-0597
Mailing Address - Fax:615-444-1251
Practice Address - Street 1:960 MADDOX SIMPSON PKWY
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37090-0751
Practice Address - Country:US
Practice Address - Phone:615-444-0597
Practice Address - Fax:615-444-1251
Is Sole Proprietor?:No
Enumeration Date:2015-02-20
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000019566363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily