Provider Demographics
NPI:1972010866
Name:FLYNN, KATHRYN MARY (DNP, PHNA-BC, RN)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MARY
Last Name:FLYNN
Suffix:
Gender:F
Credentials:DNP, PHNA-BC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 CYPRESS POINT DR
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08215-5124
Mailing Address - Country:US
Mailing Address - Phone:609-457-5365
Mailing Address - Fax:
Practice Address - Street 1:671 CYPRESS POINT DR
Practice Address - Street 2:
Practice Address - City:EGG HARBOR CITY
Practice Address - State:NJ
Practice Address - Zip Code:08215-5124
Practice Address - Country:US
Practice Address - Phone:609-457-5365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-02
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR06238700163WC0400X, 163WC1400X, 163WX0106X, 163WC1500X
NJ29NR06238700163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1400XNursing Service ProvidersRegistered NurseCollege Health
No163WS0200XNursing Service ProvidersRegistered NurseSchool
No163WX0106XNursing Service ProvidersRegistered NurseOccupational Health