Provider Demographics
NPI:1760067458
Name:FLANNIGAN, JOHN JEROME
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JEROME
Last Name:FLANNIGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 VALLEY GREENS RD
Mailing Address - Street 2:
Mailing Address - City:BRANDENBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40108-7154
Mailing Address - Country:US
Mailing Address - Phone:502-321-4847
Mailing Address - Fax:
Practice Address - Street 1:230 VALLEY GREENS RD
Practice Address - Street 2:
Practice Address - City:BRANDENBURG
Practice Address - State:KY
Practice Address - Zip Code:40108-7154
Practice Address - Country:US
Practice Address - Phone:502-321-4847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-14
Last Update Date:2021-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251722101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty