Provider Demographics
NPI:1912188459
Name:FLYNN, KIMBERLY DEEN (MAT,CBRS,ITFS-P)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:DEEN
Last Name:FLYNN
Suffix:
Gender:F
Credentials:MAT,CBRS,ITFS-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 MANCHESTER TRL
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-5382
Mailing Address - Country:US
Mailing Address - Phone:919-585-4425
Mailing Address - Fax:
Practice Address - Street 1:125 MANCHESTER TRL
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27527-5382
Practice Address - Country:US
Practice Address - Phone:919-585-4425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist