Basic Information
| Provider Information | |||||||||
| NPI: | 1174980320 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FLYNN | ||||||||
| FirstName: | KERRY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2349 APACHE ST | ||||||||
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| City: | MENDOTA HEIGHTS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551201605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128671715 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2525 CHICAGO AVE | ||||||||
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| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554044518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128136000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2016 | ||||||||
| LastUpdateDate: | 01/19/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | R-193978-5 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.