Provider Demographics
NPI:1891392783
Name:FLYNN, BETHANY
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:FLYNN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 HEALY SPUR RD
Mailing Address - Street 2:
Mailing Address - City:HEALY
Mailing Address - State:AK
Mailing Address - Zip Code:99743
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:137 HEALY SPUR RD
Practice Address - Street 2:
Practice Address - City:HEALY
Practice Address - State:AK
Practice Address - Zip Code:99743
Practice Address - Country:US
Practice Address - Phone:907-683-2223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK110716146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic