Provider Demographics
NPI:1538940911
Name:FLYNN, JESSICA KATHLEEN
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:KATHLEEN
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 1:3369 LILY MAGNOLIA CT
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-3857
Mailing Address - Country:US
Mailing Address - Phone:706-318-6170
Mailing Address - Fax:
Practice Address - Street 1:1500 LANGFORD DR BLDG 100
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-7298
Practice Address - Country:US
Practice Address - Phone:706-548-1216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN183558363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics