Provider Demographics
NPI:1265096663
Name:FLYNN, RACHEL HOUGH (PA)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:HOUGH
Last Name:FLYNN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:ELIZABETH
Other - Last Name:HOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:15 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-7997
Mailing Address - Country:US
Mailing Address - Phone:207-621-8880
Mailing Address - Fax:
Practice Address - Street 1:15 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-7997
Practice Address - Country:US
Practice Address - Phone:207-621-8880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-01
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MEPA2080363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program