Provider Demographics
NPI:1811036767
Name:FLANAGAN, JAMIE S (FNP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:S
Last Name:FLANAGAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 CAHILL RD
Mailing Address - Street 2:STE 204
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-2036
Mailing Address - Country:US
Mailing Address - Phone:417-335-7296
Mailing Address - Fax:417-335-7588
Practice Address - Street 1:121 CAHILL RD
Practice Address - Street 2:STE 204
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-2036
Practice Address - Country:US
Practice Address - Phone:417-335-7296
Practice Address - Fax:417-335-7588
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002031429363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201348OtherMO BLUE SHIELD
MO427276605Medicaid
AR159887758Medicaid
Q44059Medicare UPIN
MO427276605Medicaid
MO825393268Medicare PIN