Provider Demographics
NPI:1336161876
Name:FLYNN, JAMIE L (PA)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:FLYNN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:L
Other - Last Name:HODGSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:114 GALLERY DR
Mailing Address - Street 2:
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2690
Mailing Address - Country:US
Mailing Address - Phone:412-831-8089
Mailing Address - Fax:412-831-2955
Practice Address - Street 1:114 GALLERY DR
Practice Address - Street 2:
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-2690
Practice Address - Country:US
Practice Address - Phone:412-831-8089
Practice Address - Fax:412-831-2955
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052720363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA166177OtherMEDICARE #