Provider Demographics
NPI:1396345195
Name:FLYNN, CLARISSA RACHAEL (PA)
Entity type:Individual
Prefix:
First Name:CLARISSA
Middle Name:RACHAEL
Last Name:FLYNN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13795 W KENTUCKY DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-3064
Mailing Address - Country:US
Mailing Address - Phone:303-547-6419
Mailing Address - Fax:
Practice Address - Street 1:13795 W KENTUCKY DR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-3064
Practice Address - Country:US
Practice Address - Phone:303-547-6419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant