1972857928 NPI number — DR. KIMBERLY NACOLE FLYNN PHARMD, BCPS

Table of content: DR. KIMBERLY NACOLE FLYNN PHARMD, BCPS (NPI 1972857928)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972857928 NPI number — DR. KIMBERLY NACOLE FLYNN PHARMD, BCPS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLYNN
Provider First Name:
KIMBERLY
Provider Middle Name:
NACOLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD, BCPS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972857928
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3470 BLAZER PKWY
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-629-7117
Provider Business Mailing Address Fax Number:
859-685-0161

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3470 BLAZER PKWY
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40509-1200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-629-7117
Provider Business Practice Location Address Fax Number:
859-685-0161
Provider Enumeration Date:
10/30/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1835P1200X , with the licence number:  014583 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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