Provider Demographics
NPI:1811700826
Name:FLYNN, ALYSE KIRKALDY (RN)
Entity type:Individual
Prefix:MRS
First Name:ALYSE
Middle Name:KIRKALDY
Last Name:FLYNN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:ALYSE
Other - Middle Name:GILLIAN
Other - Last Name:KIRKALDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2602 ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2409
Mailing Address - Country:US
Mailing Address - Phone:318-317-9025
Mailing Address - Fax:
Practice Address - Street 1:3023 NOTTINGHAM DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71115-9441
Practice Address - Country:US
Practice Address - Phone:318-564-3393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-31
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA208990163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse