Provider Demographics
NPI:1700297314
Name:FLYNN, KATHLEEN W (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:W
Last Name:FLYNN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 FRIENDSHIP DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11778-9655
Mailing Address - Country:US
Mailing Address - Phone:631-744-1084
Mailing Address - Fax:
Practice Address - Street 1:65 FRIENDSHIP DR
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778-9655
Practice Address - Country:US
Practice Address - Phone:631-744-1084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10 265056164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse